29-338 (3) 220 ACREBROOK DR BP-2016-1508
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-338 CITY OF NORTHAMPTON
Lot:-OW PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2016-1508
Project# JS-2016-002574
Est.Cost$2606,00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(su. ft.); 10628.64 Owner: DAN ELS FUGEI,E H[ MARY&EDWA
Zoning:zoingL. Applicant AMERICAN INSTALLATIONS LLC
AT: 220 ACREBROOK DR
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413)552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:6/162016 0:00:00
TO PERFORM THE FOLLOWING WORK.:ATTIC & BASEMENT INSULATION &AIR
SEALING THROUGHOUT
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: ii: 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 6/16/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck Building Commissioner
File# BP-2016-1508
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 220 ACREBROOK DR
MAP 29 PARCEL 338 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid CL* a 7n6 f(.6
Building Permit Filled out
Fee Paid
Typeof Construction: ATTIC&BASEMENT INSULATION&AIR SEALINQ THROUGHOUT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Slructpce
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
INFOB.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
/D-►olition Delay
}.i,"(j'c —, sem
Sign ure o oiling 9 ficial '"r 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
City of Northampton &awe of Pam .
RECEIVC. Building Department ixab Gut Dd eaay?e alit
212 Main Street Sat`rerAys bli<Y,
Room 100 WatarANelAv1MMIL7.
North ,MA 01080 TM?o Ssts ofstnStTuml Plara
too : 413-587-1240 Fax 413.587-1272plmisYehmns
mar— .. .._. :.
APPLICATION TO CONSTRUCT.ALTER,REPAIR,RENOVATE OR DEMOLISH ACNE OR TWO FAINLY DWELLING
SECTION 1-SITE INFORMATION
1.1 PropsKyAddress: This mon elto be emnpleted by office
Map Lot 'DMR,__
220 Acre Brook Drive Florence, MA 01062 zone Overlay pistlfot
Eia St Markt. - GB Mama
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
$,1 Ownerof Record'
Gene&Karen Daniels 220 Acre Brook Drive Florence,MA 01062
Name(Print) Coned
( 320-1502Address:
See attached - Tdephoe
Signature
WARMS
American Installations 130 College St., Ste 100 South Hadley, MA 01075
Nene(Ph4) - cared MaPnl Adde=
American Installations — Ubu V. G„n/'--" 473-552-0200
agnates TO110011e
SECTION 3-ESTIMATED CONSTRUCTION COSTS
item Estimated Cost(Dolars)to be Official Use Only
completed by mamma applicant
1. Bating 2600.00 (a)Butting Permit Fee
2. Electrical (b)Estimated Total Cost cif
Construction from(I)
3. Plumbing Building Permit Pee
4. Mechanical(HVAC)
5.FIM Protection
I. ,�j
Tado(1+2+3+4+5) 2600.00 Check Number c. `Y
775 (AS
This Section Par Official Use Only
Date
Building Permit Number:
Signallers
guiding Commissioner/inspector of BuklInge pale
Section 4. ZONING AB Information Must Be Completed.Permit Can Be Denied Due To Incomplete informatko
Existing Proposed Required by Zoning
This etwa,to be UM in by
SmlimeDepraimeal
Lot Size I I
Frontage I
Setbacks Front
Side L:I I R: L=1 RI I
Rear I I
Building Height I
Bldg square Footage I % I
Open Space Footage
°.tares minus bide apan d I I
parting)
#of Parking Spaces
FBI: I
(wises alausdm) I f`
A. Has a Special Pemdt/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 0 DONT KNOW 0 YES 0
IF YES: enter Book I I Page and/or Document#I
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 0 Obtained 0 ,Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF 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. WM the construction activity disturb(deadng,grading,excavation,or firm)over l acre oils It part of a common plan
that w®dlsWm over acre? YESO NO 0
IF YES,then a Northampton Storm Water Management Penult from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK Icheck an applicable)
New House p Addition p Replacement Windows aaralwn(s) ❑ Rooting p
Accessory Bldg. ElDemolition ❑ New Signs [7] Decks Ip Siding O I Other tit
Work Atm?and asb ement insulation and air sealing throughout
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narra ve Renovating ungnished basement Yes No
Plan Attached Roll -Shed
. .
m.N New house rhndoTadriition to oxisNTw houslna..comPlete the following:
a. Use of building:One Family Two Family Other
b. Number of rooms in each famly unit Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of Modes?
f. Method of heating? Fkeplaces or Woodstoves Number of Oath
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
I. Is construction within 100 ft.of wedands? Yes No. Is conekudlan wt h 100 yr. floodplain Yes No
I. Depth of basement or cellar floor below finished wade
k. WB tending 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• as Owner of the subject
proPemy
hereby authorize American Installations
to act on my behdf,In sI metas relative to wok authorized by this building permit application.
See attached 6/14/2016
Signature°WOeser Date
I, American Installations as Omer/Authorized
Agent hereby declare that the statements and Information on the foregoing application are the and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties ofpenury.
American Installations
Print Nan
)(A./IS (L (N 6/14/2016
Signature ofOwnedAgas Doe
s'CTIIDN 6-CONSTRUcnON SERVICES
g.1 Llcanaed Construction Suoadcor. Not Augustin O
[tams entente WAS:ri Wesley K. Couture 106178
n_lbtuar
130 College St., Ste 100 South Hadley, MA 01075 9/29/17
Address Ewirsam Or
se.)LA �i v 413-552-0200
sin.. 7elophore
O.Rwbbmaltornelmoiovanatit�osNirdor _ _.,. - . _.,. Not Applicable CI
Wesley Couture 175982
Company Name Repines° Matter
American Installations 6/27/17
Address Empkallcn Date
130 College St., Ste 100 South Hadley, MA 01075 7fe 413-552-0200
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIOAWU(Magi 4102,G 2S(6))
Workers Compensation insane affidavit must be completed and subedited with chic appr. ton.Failure lo provls tli alfdavAwU testi
In the denial of the lewance of 0e buid%pond[
Stead MfdaaG Attached Yea.._... f$ No.__ 0
.. _ __ _. . _ . _ . sass sass
11. -Home OWner.ttemption
The crarent exemption for`bommenenn we.emended to include Oww•ocaud W Rwandan of ore(1) or rw(2)I milt
and to allow such homeowner to engage en individual for hire who does not poison a license,provided dial the owner acts
6s eoperybor.CMR 700. Strut Edidon Section 10¢3.5.1.
Definition of Aameonarr.Pelson(s)who own a weal of land on which hdshe resides or intends to reside,on which them
is,or is intraded to be,a one or two family ung,eluded or detached stammer accessory to mth use and/or farm
structures.A versa who team.ets man than one home In a two-year pealed shag not be mouldered a homeowner.
Such"'bommeownee shut submito the Building Official,on a form acceptable to the Building 0Qcial,Mat Webs shall be
ynmorsthle for W sock work unified under the buldleeosml(,
As seting Csuahwction Supervisor your presence on the Job site will be required from Gad to time,dining end upon
oorpkaon of the work far which this port a famed.
Alm be advised that with mfreace to Chapter 152(Waken'Compensation) and Chapter 153(Liability of Employes to
Employee for injuries not molting in Death)of die Masehmclb Genal Laws Annotated,you may be Gable for p racm(s)
you hue in pert®work for you order ibis permit_
The undenigoed"bomeowmer certifies and swum respombilhy for compliance with the State Bolding Code,Gly of
Northampton ONlance.,State tad Local Zoning Laws rod State ofMaaecbwM Gan'Laws Annotated
Homeowner Sigoaere
City of Northampton
etassachusetts ;`e
„3 OFFAMO81z OF MOM& nr$pzaro .+
212 Main Street • Municipal building •1‘...,____(.0
eetthaptte, b 01060
Property Address: 220 Acre Brook Drive Florence, MA 01062
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City,State: South Hadley,MA
Phone: 43-552-0200
Property Owner
Name: Gene&Karen Daniels
Address: 220 Acre Brook Drive
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 1 /
Date 6/14/2016
Licensed&Insured • www.Americaan�ailations.com
MACS{it room American Installations
MA fln9Lsrmtia X175982
-Efficient Homeservicn-
130Cornea Street Seita 100,South Hadley,MA 03075 •PMke:(4131552-0200 Fax:(413)5524202• email:supportrAmericanletilallatIons.own
AIR SEALING PROPOSAL
Gene Daniels
220 Acrebrook Dr
Florence,MA 010624502
Site ID:500050193169
Project ID:P00050221470
Customer ID;C00050194670
Contract ID:20160520 ASEAL
Deacrlpllon quantity Location
Sorban Air Sealing at Estimated 62.5 CPM50 Pa Hour 10 living Sfax `_$84320
Exmoor Dear Weather StriPleinti 2 NIA $55.18
Owe Sweep 1 NIA $23.18
Sub Teats 5921.56
Milky Inventive Share $921.56
Customer Contribution $0.00
WARRANTY-:American installation,ttC will provide the above stated homeowner with a 2 yew workmanship warranty.
American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications
and a local and Rale building reguSions to the Tout Contract Value as stated herein.
ACCEPTANCE OF PROPOSAL:The above prices,spedfluaons and conditions TOTALCONTRACT VALUC=S 0.00
ar e satistactory and are hereby accepted.You are authorized to do work as noon Payment=$ 0.00
specified.Payment will be 113 down prior to start of work,and balance due PAID
upon Completion. -�+ Balance Du Completion=S 0.00
Signature pate 5/20/2016
Property owner(Print) Daniels,Ge_____. v (sign) Date
Representative:(Print)_CS A Oregoth Olen) ., / Date 5(2012016
AGREEM em Er Tile PCV IES'NvOI von.I.
vlD ORboWn, OF!NE
ucxexnxunx xannaeowo ora mmvaxr.AND m rvnEn�si xunscoaUmx,memumVruuomvEs ana..woLLunn lualS CReilt erxaouneuws�wEeulnno.s.wouaax.wnams
Licensed&Insured `• www AmericanIMS20ationiCQm
MA CST fi'106178 American Installations
MA Registration#175982
-Ent kMlbmeServicM-
341 Newton Skeet South Hadley,end 010)5 • Oflke;(4131 9 9 2 4 20 0 Fax:(411)552-0202 • Email:wpporteAmerianInsuil tbm.com
WEATHERIZATION CONTRACT
Gene Daniels
220 MaS:ookk Dr
Florence.MA 01062-3502
Site ID:500050193169
Project ID:P00050221470
Customer 0000501416711
Contract ID:20160520 WORK
Deemfptlen Quantity Locator
Insudate Rin Mist Wmi 2'Thermal flamer PWyleo 52 LiWgspace 5229.80
Insulation Ren anal 52 N/A 559.80
Atop Eta Cost Blew Cellulose 5' 960 Living Space S1544&IO
HatotyThermal 53aner pdyleg2Inch(C) _._ 1 LMi ace __..— $4171
Damming 15 NIA $32.65_
Sub Total: $1707.16
USW Incentive Share $1235.52
Cuatauwr Contribution 147184
WARRANTY:American Installations,ILC wig provide the above stated homeowner with a 2 year workmanship warranty.
American Installations,4C hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above speci`iaations
andel;local and State braga%regtdations for the Total Contratt Value as stated herein.
ACCEPTANCE OP PROPOSAL:The above prices,specifications andcondltimis TOTAL CONTRACT VALUE=$ 471.64
aresatisfactory and are hereby accepted You are authorized to do work as
Down Payment=$ 15).00
specified.Payment will be 1/3 down prior to start of work,and balance due AI 5/20/)016
PAID
upon Completion. L�///f///f Balance Due Upon Completion 314.64
Signature /"""' V Date 5/20/2016
Property Owner/print) Daniels,Geoe&Karen &t Date
(Sign) Da
Representative:(Print/ "Tail • .La_ov;,, ,,,,_(Sign) Date 5/20/2016
Apo THE„yam BE cw4SLFam ME ENTRE AGREEMENT ST Tatc.ana mom,THIS apanMENTIS erm.:a AMewwrwwulnnOm.
uc HV"'IMrtz RMPREnTO.at OMPnw',AND T. MERONAM DD.aowE.F8REIF .TEa anEaamTDau'amr-,AND.ILL SE aUWECTTCMLL AP QPRIAM LAWS,REluunoasrae ORDINANCES OF THE
swaOFM.,wm�:rT�arcwnErna.TaasGrcnm.....war...r Ma r«u waimIamz.
The Commonwealth of Massachusetts
1a r ,— Department of Industrial Accidents
s11 ,= OffiiceofInvestigations
z i�= I Congress Street,Suite 100
,1„ , Boston,MA 02114-2017
am
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 Street,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 27 4. ❑ 1 am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑ w construction
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' 9. 0 Building addition
[No workers' comp. insurance comp insurance.:
required] 5. ❑ We are a corporation and its IOU Etesu ieal repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152,§1(4),and we have no instAaiion
employees. [No workers' 13.®Other
comp. insurance required.)
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit ibis affidavit indicating they am doing as work and then hire outside crmtractorsmuat submit anew affidavit indicatiryl such.
teonimetors that check this box must attached an additional sheet slowing the name of the rub-contractors and Maze whether or not arose entities have
employees. lithe svbcanaectors have employees,they must provide their workers'comp.policy number.
l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: (canard insurance Companies
Policy#or Self-ins. Lic. #: URWC609917 Expiration Date: 09/04/2016
Job Site Address:-2-2-0 ar...4.t.. 13 n.tM City/State/Zip: At4l'\.Q9 1"-14 k. O I O b 2
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 ccQertify under the pains andpenaltiesof perjury that the information provided above Is true and correct.
SimatwJr.M 9 on/./th L Date: Lo (S t 20 )i,
*cum #: - Y:' #• oe
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: PermittLicense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
AMMO CERTIFICATE OF LIABILITY INSURANCE g„` g”5
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. TINS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE. ISSUING INSURERS), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND WE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)mud 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 endonement(s).
PRODUCER tkINTNA ACT Linda Powers
Webber a Grinnell pIAME E (419)586-0111 —a Nor t 61315116-6491
8 North Ring Street �M"n-
.AOOaiss: powerT4webberendgrinne11,COW
INSURERISI AFPOROIN0 COVERAGE NANCY
Northampton HIL 01060 sisu ABmrs1oyere thltual CaaualtY
INSURED ... nevmFR a AnGDARD/E8 SV.BD
American Installations, LLC INSURER C:
Attn: Wes 6 Suzanne Couture INSURER O:
130 College Street Suite 100 FISURERE:
South Hadley COL 01075 aN11RERP: ........
COVERAGES CERTIFICATE NUMBER Mas tar 9-2015 REVISIONNUMBER
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 CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTNN. 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.
TYPE OF mgURAICE PoNCS'(�FP POLICY6XP
le so We p0{1CY MJ%sER IMWDLVYYY1ry UMwOOntnII t1Mn5
X COMMERCIAL GENERAL Linen EACH OCCURRENCE 1,000,000
A X CLAIMS-MADE __IOCCUR PREMISES Oa prynpaal 50,000
503535216 9/4/2015 9/d/201E MED EXP(Any(Re Pee) 10,000
_ PERSONAL&AOM INJURY 1,000,000
GENT AGGREGATE LIMIT HIVES PER: GENERAL.AGGREGATE 2,DD0,000
X POLCY T __...
.IECT ri LAC PRODUCTS-CCMPAPACw 2,000,000
OMNER.
AmOI4DN48 WBILm ICEOMWSINGLE LIMIT S 1,000,000
A _MNYALTID BODILY INJURYlevee l $
NJ.ONNED [j SCHEDULED- _
plj{0y X ♦At�m�NyVEO. $E3535216 9/A(203$ 414(2016 BODILY IUfIE.Mot. NaQ 5
X reel AUTOS AUTOS O IPeram2 OMA i
PIP-Basic 5 8,000
X UMBREt1A LIAR Mae EACH OCCURRENCE 5 1,000,000
—
A EXCESS we CLAIMS-MADE AGGREGATE $ 1.000.000
IED XI RETENTIONS 10,000 553535216 9/4/2015 9/6/2016 S
i€pWOMUSRS C4PB1aUTSN 1PPPoTgiUTE ERN
NIT PRCPRIETIXW, TIY!HR,EXECUTIVE EL EACH ACGDEHr $ 500,000
OFFICERMEMRm EVAUDED7 NIA
B /YMyaand M� OPMC6D9917 9i4/2915 9/4(2016 EL DISEASE-EA EMPLOYEE S 500,000
CESCRIPTIONGF OPERATIONS below E.L OISEASE-PCUCY LIMIT $ 500,000
A Commercial ri.e+.ty S 353521.6 9/412015 9/4/2016 epee STSCO 20,000
MwcJNe Sipe 40,000
OESCRW11ON or oPEMTN NSILOCATKKIS IVEHICLE.O MCORO 501,Adanne Regie SMmen.may be ended N nNrt span a...MMU
Proof of Coverage. Workers' Compensation policy includes class code 5979
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OP THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTII D RBMESETUA1Wa
Kevin Joyce/IMP L
91988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
IN8025erswe:
Massachusetts-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
Construction
Suoe
License: 178
cckTll "
wean �` "
SLEY
166 NORIHMAM p
South Hadley MAFO1 `
Failure to possess a current edition of the Massachusetts
Sys asa -State Building Code is cause for revocation of this license.
g-.72...-,0:-..ger-0^ Expiration
Commissioner 09/29/2017 For DPS lfmsingintonnz6an wait www.Mass.Gov/ovs
dJ V/
II .F i0 ' ,I It . 4
� , Office of Consumer Affairs and Busi ss Reg' lation
e I t
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 175982
Type: LLC
Expiration: 6272017 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 I Si 20MOsn, Address 0 Renewal E Employment Q Lost Card
die Yr .ea///,/crll ./rt cm
Office ofConsumer Affairs&Business Regulation License or registration valid for individul use only
R OME IMPROVEMENT CONTRACTOR
9before the expiration date. [!found return to:
ogistradon: 115982 Type: Office of Consumer Attain and Business Regulation
ExpimOon 6272017 LLC 10 Park Plaza-Suite 5170
Boston,MA 02116
AMERICAN INSTALLATIONS,EL-C.
WESLEY COUTURE " /
130 COLLEGE STREET SURE 100 s_ i- ,� ////9� //^/!,/
SOUTH HADLEY MA 01075 Undesecretary - N valid without signature