31A-165 (3) 92 MAYNARD RD BP-2016-1562
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block:31A- 165 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: INSULATION BUILDING PERMIT
Permit# BP-2016-1562
Project# JS-2016-002667
Est.Cost: $5000.52
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq. ft): 7492.32 Owner: OLSSON DAVID B&JEAN E ZIMMER
Zoning: URB(100)/ Applicant: AMERICAN INSTALLATIONS LLC
AT: 92 MAYNARD RD
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:6/29/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC & BASEMENT INSULATION &AIR
SEALING THROGHOUT
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 6/2920160:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck- Building Commissioner
File N BP-2016-1562
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 92 MAYNARD RD
MAP 31A PARCEL 165 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED QUT
Fee Paid C.0 Pt— ?3?W (QC '
Building Permit Filled out
Fee Paid
'fvpeof Construction: ATTIC& BASEMENT INSULATION&AIR SEALING THROGHOUT
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
INFO TION 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 Variances
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. ition Delay
_ %� � d 7Y/
Sig • rerBu di-_0 ficia 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.
16-1161
h
/' / 1lepartment use-wily
(3/ Cis as of Pem IC
Building Department curb cuuonveway permit
Q ec 212 Main Street Sewer/Septicavailabllity.
Room 100 Water)WeH Avaiablly,.
/ Northampton, MA 01060 Two Sets of Strut ret Plans
d phone 413-587-1240 Fax 413-587-1272 plot/Site plan's
OtineSpedry
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
92 Maynard Road Map Lot Unit
Northampton, MA 01060 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Jean Zimmerman 92 Mayna�arrd Road, Northampton MA 01060
Name(Print) Cur4rent Magillg3-584l 0A9ress
See attached - Telephone
Signature
2.2 Authorized Agent
American Installations 130 College St., Ste 100 South Hadley,MA 01075
Name(Print) - Current Mating Address:
American Installations 413-552-0200
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Esgmated Cost(Dolars)to be OMdal Use Only
completed by permit applicant
1. Building 5000.52 (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) 5000.52 Chedc Number a 2 g9 4 62c—
This Section For Official Use Only
Bulding Permit Number: Date
DIssued:
Signature:
Buldfrg Commissioner/inspector of Buildings Date
Section 4. ZONING Alt 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 Dgmiment
Lot Size
Frontage I
Setbacks Front
Side L: I L: R:
Rear 11 l
Building Height I �I
Bldg.Square Footage % I
Open Space Footage Yo
(Cm arca minus bads dr paved I 1 I I I III
parking)
#of Parking Spaces F-1
Fill:
(volume&Lowdoo)
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 O YES O
IF YES: enter Book I I Page and/or Document
B. Does the site contain a brook, body of water or wetlands? NO O DONT 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:
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(deadng,grading,excavation,or fining)over I acre or Is it part of a common plan
that will disturb over i acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition 0 Replacement Windows Alteration(s) ❑ Roofing El
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs ICH Decks [D Siding[[) Other[IXI
Brief Description of,Proposed
Work: Attic and basement insulation and air sealing throughout
Alteration of Sating bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _ Yes No
Plans Attached Roil -Sheet
_.
se.N New house apd or additionto existing housinq,complete the followinq:
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 Consecration 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 Ctywater Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, lean Zimmer ,as Owner of the subject
property
hereby authorize American Installations
to act on my behalf,in an matters relative to work authorized by this building permit application.
See attached 6-23-16
Signature of Owner Date
I, American Installations as Owner/Authorized
Agent hereby declare that the statements and Information on the foregoing application are hue and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
American Installations
Print Name
American Installations 6-23-16
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor; Not Applicable D
Name ofucense Holder: Wesley K. Couture 106178
License Number
130 College St., Ste 100 South Hadley, MA 01075 9/29/17
Address /� Expiratim Date
.LL,.KG" 413-552-0200
signature Telephone
9.Registered Home Improvement Cohfractoc . - Not Applicable ❑
Wesley Couture 175982
Company Name Registration Number
American Installations 6/27/17
Address Erpiration 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 this affidavit will result
in the denial of the Issuance of the building permit
Signed Affidavit Attached Yes N No ❑
11. -Home Owner Exemption
The cutest exemption for"homeowners"was extended to include Owner-oven Med 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 1118.3.5.1.
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 N 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 he
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)oftheMassachusetts General laws Annotated,you may 6el1a491erpersoa(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 3 £- 4
ei !
DEPARTMENT OF BUILDING INSPECTIONS qi
212 Nair Street • Mv,icipal Building
Northampton, NA 01060 yJn
Property Address: 92 Maynard Road
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property Owner
Name: Jean Zimmer
Address: 92 Maynard Road
City, State: Northampton, MA 01060
1,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
Date 6-23-16 �j'�
mai
econotnia
Licensed&Insured \ www.Americanlnstallations.com
MACIL".106178 American Installations
MA Regis Varian 175982
-Efficient Home Services-
130 College Street Suite 1W,South Hadley,MA 01015 • Office:(413)552-0200 fax:(413)552-0201 • Email:SU•part@Amerionlnstallalions.com
AIR SEALING PROPOSAL
Jean Zimmer
92 Maynard Rd
Northampton,MA 01060-2810
Site ID:500050200356
Project ID: P00050229703
Customer ID:000050201856
Contract ID:20160615 ASEAL
Description Quantity Location
Perform Air Sealing at Estimated 62.5 CFM50 Per Hour t Living Spas 684.32
Exterior Door Weather SITCOM _ 3 WA _.. 562.77
Door Sweep 3 WA $69.54
Sub Total: $236.63
Miley Incentive Share $236.63
Customer Contribution $0.00
WARRANTY:American Installations,LLC will provide the above stated homeowner with a 2 year workmanship warranty.
American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the abovespecifcations
and all local and state building regulations for the Total Contract Value as stated herein.
ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions TOTAL CONTRACT VALDE=$ 0
are satisfactory and are hereby accepted. You are authorized to do work as
Down Payment=$ 0 ❑
specified.Payment will be 1/3 down prior to start of work,and balance due PAID
upon Completion. Balance Due Upon Completion-$ 0
Signature / V Date 6-15-16
Property Owner(Print) (Sign) Date
Representative:(Print) (Sign) D Date 6-15-16
ma AGREEMENT IS COMPOSED Of THIS PAGE AND 111E REVERSE SIOF OF 11-115 PAGE AND SHALL BE CONSIDERED TIE EMIRS AGREEM E BY THE PAPP ES INVOLVED THIS AGREEMEN7 IS BEIWEEN AMERICAN INST411110145.
LLC XEsewurze REFERRED 10 ns mmru,,AN menplmAPPROPRIATE LAWS,AEsmATONS um ORDINANCES OF
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 ON THE REVERSE SIDE,HEREINAFTER
REFERRED TO AS"CLIENT",AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS MID ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT
RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS.
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 ANY CONDITION.
2. SHOULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(1-1/2)
PERCENT PER MONTH.(18%PER ANNUM)WITH A MINIMUM CHARGE OF$203 PER MONTH.AND IF PLACED IN THE HANDS OF AN ATTORNEY OR COLLECTION AGENCY
FOR COLLECTION.ALL ATTORNEYS'FEES,EXPENSES AND COSTS OF COLLECTION SHALL BE PAID BY THE CLIENT. IN ADDITION,CLIENT UNDERSTANDS THAT IN FAILING
TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY HAVE THE RIGHT TOA ZEIN 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,NOTWITHSTANOING ANY AGREEMENT FOR MATERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY IS RESPONSIBLE
TO CLIENT FOR COMPLETION OF ALL WORK DESCRIBED IN ATIMELY AND WORKMANLIKE MANNER.
5. ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS OF SUCH
EQUIPMENT AND PRODUCTS. UNDER SUCH MANUFACTURER'S WARRANTIES,THE CLIENT MAY BE REQUIRED TO REGISTER OR MAIL IN A WARRANTY CARD OR OTHER
EVIDENCE OF OWNERSHIP MID USE OF SUCH EQUIPMENT AND/OR PRODUCTS IN ORDER 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 SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT.
T. THE 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 SOLEY DUE TO THE COMPANY'S NEGLIGENCE.
8. DURING THE DURATION OF THE WORK,THE CLIENTS HOMEOWNERS INSURANCE WILL BE RESPONSIBLE FOR ANY AND ALL DAMAGES AS LONG AS THE COMPANY HAS
TAKEN THE APPROPRIATE ACTION TO PROTECT AREAS OF WORK.
9. 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. IFA PRE-EXISTING DEFICIENCY
OR HAZARDOUS MATERIAL IS ENCOUNTERED PRIOR TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING,COMPANY WILL TRY TO ASSIST CLIENT
WITHIN THE COMPANY'S MEANS AND CAPABILITIES TO CORRECT THE PROBLEM(S)ON A TIME AND MATERIAL BASIS. CLIENT 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 OF COMPLETION MAY DIFFER FROM THAT AGREED UPON.IF APPLICABLE,UNDER THIS AGREEMENT.
10. THE COMPANY IS NOT RESPONSIBLE,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES,INLCUDING 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 5 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,ROOF JACKS,VENTILATORS,FLASHING,RAFTERS,JOISTS,INSULATION OR OTHER MATERIALS ARE NOT
INCLUDED UNLESS OTHERWISE 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,HAIRLINE FRACTURES 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. THE COMPANY UNDER PROVISIONS OF CHAPTER 142A OF THE GENERAL LAWS IS REQUIRED TO APPLY FOR AND OBTAIN ALL CONSTRUCTION-RELATED 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.
15. THIS AGREEMENT,INCLUDING THE PROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE,CANNOT BE CHANGED OR ALTERED EXCEPT BY AWRITTEN 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.
17. THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES IXCEPT AS OTHERWISE SET FORTH HEREIN.
18. THISAGREEMENT.AND ANY WARRANTY(S)PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY OR WITH THE WRITTEN PERMISSION OF THE COMPANY.
19. IF THE CLIENT FAILS TO PERFORM ITS.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 FOR RESTOCKING FEE.
20. ANY CHANGES TO MATERIALS BY THE CLIENT(BRAND,STYLE,COLOR,ETC.)AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT
IN A 5%RE-STOCKING FEE BASED ON THE COST OF SAID MATERIALS.
21. THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL.THE COMPANY
RESERVES THE RIGHT TO REVOKE THIS PROPOSAL 90 DAYS FROM DATE IT IS EXECUTED BY THE COMPANY IF IT IS NOT EARLIER EXECUTED BY THE CLIENT AND THE
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. IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCEBILITY OF THE REMAINING PROVISIONS OF
THIS AGREEMENT SHALL NOT BE AFFECTED THEREBY.
23. ARBITRATION:IN THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS,CONDITIONS PROVISIONS,OR PERFORMANCE OF THIS
AGREEMENT,THE PARTIES AGREE TO PLACE THE MATTER INTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION
ASSOCIATION TO RESOLVE THEIR DISPUTE.
24. ANY DISCOUNT.PROMOTION.REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM(I.E.MASS SAVE°)IS SUBJECT TO THE
AVAILABILITY OF QUALIFYING STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTILITY 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 UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE ENERGY
PROGRAM.
26. CUENT IS REPSONSIBLE FOR THE PAYMENT OF ANY AND ALL FEDERAL,STATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AGREEMENT.
9
orenzea&Insured • reanweess
ceaterte
www.Americanlnstallations.com
MA CSL I:106118 American Installations
MA Registration P 175982
-Efficient Home Services-
130 College Street Suite 100,South Hadley,MA 01075 • Office:(013)552-0200 fax:1413)552-0202 • Email:support@Amerkanlnstallations.com
WEATHERIZATION PROPOSAL
Jen Ziemer
92 Maynard Rd
V9eNarnpuA,MA 0I060-2810
Site ID:9M0562IO354
Project IO.P00030229703
Customer ID. C000602O1R56
Contract ID.20160615_WORK
Daa.rlon Quanary lolls'
ffiWalm Removal 1115 WA $112q
Yalta Rin Joie M IT Mind Brim Poly/so 113 LnegSpone 119 220
9sNOAmaa 2 IIIA 62210
trelaDem Paca11e9Me. Onotwehorned rYaPWls' 1115 idea Spa i22AAD
ScFlo Ed .dCc lnoa.Mu OW IJJr Soar 5451.130
Ao floe Erd®d Gime Dense Pad B' 1010 Lada Sada 613.1930.0
Dow 1Mmd Bents PaflaoT WW1 I Laing$ma fYLV
BSO Taft 14.21180
U111112 banned`a 62.00080
culls camels u,n3al
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 specificatons
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=$ 2763.89
are satisfactory and are hereby accepted. you are authorized to do work as
Down Payment=$ 921.00 g] 6-15-16
specified.Payment will be 1/3 down prior to start of work,and balance due PRIG
upon Completion. Balance Due Upon Completion=$ 180 R9
Signature 9 3 Date 6-15-16
Property Owner(Print) (Sign) (^/ Date
Representative:(Print) (sign) \ ( V ._ Dee 6-15-16
-
THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIOE 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 ON THE REVERSE SIDE,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.
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 OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(1-1/2)
PERCENT PER MONTH.(38%PER ANNUM)WITH A MINIMUM CHARGE OF$2.00 PER MONTH,AND IF PLACED IN THE HANDS OF AN ATTORNEY OR COLLECTION AGENCY
FOR COLLECTION,ALL ATTORNEYS'FEES EXPENSES AND COSTS OF COLLECTION SHALL BE PAID BY THE CLIENT. IN ADDITION.CLIENT UNDERSTANDS THAT IN FAILING
TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY HAVE THE RIGHT TO A 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 IS RESPONSIBLE
TO GHENT FOR COMPLETION OF ALL WORK DESCRIBED IN A TIMELY AND WORKMANLIKE MANNER-
5. ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS OF SUCH
EQUIPMENT AND PRODUCTS. UNDER SUCH MANUFACTURERS WARRANTIES,THE CLIENT MAY BE REQUIRED TO REGISTER OR MAIL IN A WARRANTY CARD OR OTHER
EVIDENCE OF OWNERSHIP AND USE OF SUCH EQUIPMENT AND/OR PRODUCTS IN ORDER 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 SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT.
7. THE COMPANY'S LIABIUTY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AGREEMENT PRICE EXCEPT TO THE EXTENT THOSE DAMAGES
ARE PROVEN TO BE SOLEY DUE TO THE COMPANY'S NEGLIGENCE.
8. DURING THE DURATION OF THE WORK,THE CLIENT'S HOMEOWNERS INSURANCE WILL BE RESPONSIBLE FOR ANY AND ALL DAMAGES AS LONG AS THE COMPANY HAS
TAKEN THE APPROPRIATE ACTON TO PROTECT AREAS OF WORK.
9. 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. IFA PRE-EXISTING DEFICIENCY
OR HAZARDOUS MATERIAL IS ENCOUNTERED PRIOR TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING,COMPANY WILL TRY TO ASSIST CLIENT
WITHIN THE COMPANY'S MEANS AND CAPABILITIES TO CORRECT THE PROBLEM(S)ON A TIME AND MATERIAL BASIS. CLIENT 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 OF COMPLETION MAY DIFFER FROM THAT AGREED UPON.IF APPLICABLE,UNDER THIS AGREEMENT.
10. THE COMPANY 5 NOT RESPONSIBLE,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES.INLCUDING 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,ROOF JACKS,VENTILATORS,FLASHING,RAFTERS,JOISTS,INSULATION OR OTHER MATERIALS ARE NOT
INCLUDED UNLESS OTHERWISE NOTED HEREIN.
13. THE COMPANY WILL NOT BE RESPONSIBLE FOR THE SCRATCHING OR DENTING OF INTERIOR WALLS AND CEILINGS,FLOORS,TRIM,GLITTERS,DOWNSPOUTS,EXISTING
SIDING AND WINDOWS.DOORS,OIL DROPLETS IN DRIVEWAYS,HAIRLINE FRACTURES 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. THE COMPANY UNDER PROVISIONS OF CHAPTER 142A OF THE GENERAL LAWS IS REQUIRED TO APPLY FOR AND OBTAIN ALL CONSTRUCRON-RELATED 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.
15. 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.
17 THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN.
18. THIS AGREEMENT,AND ANY WARRANTY(S)PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY OR WITH THE WRITTEN PERMISSION OF THE COMPANY.
19. IF THE CLIENT FAILS TO PERFORM RS 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 FOR RESTOCKING FEE.
20. ANY CHANGES TO MATERIALS BY THE CLIENT(BRAND,STYLE,COLOR,ETC./AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT
IN A 5%RE-STOCKING FEE BASED ON THE COST OF SAID MATERIALS.
21. THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL.THE COMPANY
RESERVES THE RIGHT TO REVOKE THIS PROPOSAL 90 DAYS FROM DATE R IS EXECUTED BY THE COMPANY IF IT IS NOT EARLIER EXECUTED BY THE CLIENT AND THE
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.
72. IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCEBILITY OF THE REMAINING PROVISIONS OF
THIS AGREEMENT SHALL NOT BE AFFECTED THEREBY.
23. ARBITRATION:IN THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS,CONDITIONS PROVISIONS,OR PERFORMANCE OF THIS
AGREEMENT,THE PARTIES AGREE TO PLACE THE MATTER INTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION
ASSOCIATION TO RESOLVE THEIR DISPUTE.
24. ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM N.E.MASS SAVE4)IS SUBJECT TO THE
AVAILABILITY OF QUALIFYING STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTILITY 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 UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE*ENERGY
PROGRAM.
26. CLIENT IS REPSONSIBLE FOR THE PAYMENT OF ANY AND ALL FEDERAL,STATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AGREEMENT.
IN The Commonwealth ofMassachusetts
Department of Industrial
,
y
Office of Investigations
600 Washington Street
Boston,Mass. 02111
www.mass.gov/dm
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /� •
Please Print Legibly
Name BmiusnIotgaatreulo+dantivdua ::�, )4th,Pften
81i LIC1sin ga+ on LL tL
Address- 130 l r-)1If Ifs". St l .
City/State/zip: &Sbu{\ Rarley MA 01615 Phoma: 413-5.502- 0 00
Are ou an employer?Checkappropriate a box: Type of project(required):
1. l am an employer with_ a, 4.01 am a general contractor and I 6.0 New construction
employees(MI and/or pm time).* have hired the nib-contractors
2.01 am a sole proprietor or partner- listed on the attached sheet. 7.ORemodeling
ship and have no employees These subcontractors have 6.0 Demolition
waking for me hi any capacity. tr.. .y.aand have workers' 9.OBuilding addition
[No workers'comp.Insurance comp.insurance.I
required] 5.0 We arc a corporation and its 10.0 Electrical repairs or additions
3.01 am a homeowner doing all work - officers have exercised their
myself [No workers'comp. right of exemption perm MGL 11.0 Plumbing repairs or additions
insurance required]s a 152,§1(4),and we have no 12.0 Roof repairs
employees.(no workers'
13:14130teritsuigitom
comp.insurance required.]
*Any applicant that cheeks box la mast'bp m out the seed=belowshowing theirworken•compound=policy Information.
tHomemmers who submitads amen ivntating they are doing N work ani Wen bin MAT!.eournators must submita new artdadtbdWdag nth.
tContaemrs that clack this box most attach a Windmill sheet showing the tame of the seb cowtratter and stak whether or not these rudders have employee if
the subcrntrmbn have employer,they meat provide their workers'temp.policy nember.
I am an empioyerthat is providing workers'compensation lnsuraucejbrmy employees.Below Is the policy and Job site
information. G U^ ra `
Insurance Company Name: n v. �r.,� --7
Policy it or Self-ins.Lie.it (UAR C� ( tPlet I I Exp ratiwyDarte:_I y I�I SID_ ��} ��
lob Site Address: � \ G l ItJ 1--1` u Clty/State/1p: L 1y(� r API DIC:16
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 fuse
up to$1,500.00 and/or one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and afine of
$250.00 a day against violator.Be advised that a copy of this statement maybe fomented to the Office of Investigations of the
DIA for coverage verification.
I do herby eat,under the pains
and penalties ofperjury that the information provided above� Is true ancorrect
d
Signature: 4 Act l L ( arll p. Date: (n (9. F Air
Print Name:&I'MAno S Cne-lrtre_, Phone I: 9i3-55a-MaoO
Ojficial use only Do not write in this area to be completed by city or town official
City or Town: Permitlltcensed:
Issuing Authority(circle one):
1.Board of Heath 2. BuidingDepariment 3.Citylrown Cleric 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact person: Phone g:
TE
AR CERTIFICATE OF LIABILITY INSURANCE w9�aMizDos
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 Linda Powers
NAME
Webber 6 Grinnell PHONE . (413)586-0111 FARM 1413)5W-640
8 North King Street ii,s,1poweregwebberandgrinnell.com
INSURER(S)AFFORDING COVERAGE NRICS
Northampton NA 01060 amuse/AEmployers Mutual Casualty
INSURED INSURERBAOGDARD/Bg GUARD
American Installations, LLC NSURERC:
Attn: Wes 6 Suzanne Couture INSURER O:
130 College Street Suite 100 04SURERE: _
South Hadley !A 01075 INSURER P:
COVERAGES CERTIFICATE NUMBERMas ter 9-2015 REVISION NUMBER:
THIS i5 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 CONOUION OF ANY CONTRACT OR OTHER DOCUMENT WTH 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.
INSRR TYPE OF INSURANCE AI
ADM M PONCY EFF POLICY EXP
sawevil POLICYNUMBER IMWOOnYYY1 IMW0 VYYI UNITS
X COMMERCIAL GENERAL WBILIT4DAMA ED 1,000,000
E70RENT
A X CLAIMS-MADE
�ILE 'OCCUR DAMA6LiAME0 PRE50,000
MIX 5 n weal
5O3535216 9/4/2015 9/4/2016 MEOFID(Mone aprtml 10,000
PERSONAL A AW INJURY 1,000,000
GENL AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE 2,000,000
X POLICY 12ef LOC PRODUCTS.COMPAP AGO 2,000,000
OTHER
AISTONOMLE Lmeury COMBI�NEDDUSINGLE LIMIT $ 1,000,000
A ANY AUTO BODILY INJURY(PM prsml $
ALL ED UITO
AUTOS K SCHEDULED 533535216 9/4/2015 9/4/2016 BODILY INJURY(Per "a &O 1
XONDNNED fS
PROPERTY DAMAGE
X HIRED AUTOS R ALTOS (PwmdM S
PE-Basic S 8,000
X UMBRSl1A LIAO OCCUR EACH OCCURRENCE $ 1,000,000
,_
A EXCESS NAR CLAIMS-MADE AGGREGATE 5 1,000,000
OED X I RETENTIONS 10,000 5./3535216 9/4/2015 9/4/2016 1
WORKERSCOMPENSATION PER OTN
AND'EMPLOYERS 11ABIIRY YIN STATUTE ER
ANY PRS fl�TTORPARTBER UNERE ECUTIVE NIA E.L EACN ACCIDENT S 500,000
B I(Mandaory N NH) OB1E609917 9/4/2015 9/4/2016 E.L DI4a5F-EA EMPLOYEE S 500,000
DtSCRIPTTIO OF OPERATIONS ANDY E.L DISEASE-MUGSLIMIT S 500,000
A Commercial Property 5A3535216 9/4/2015 9/4/2016 *Wed*SLO_ro 20,000
6eawe*51.600 40,000
DESCRIPTION Of OPERATORS)LOCATIONS I VEHICLES ACORD 101.AddMonal Remarks Sc4N01e,may be items If more same isreq iem
Proof of Coverage. Workers' Compensation policy includes class code 5474
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NONCE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUPKMITED REPLS5aoAliVE
Kevin Joyce/LMP
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025nmrnn
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(991m3)of
Construction Superv-1061isor enclosed ,
space. •
License:CS 766778
WESLEY COUTO* ., 'fG
166 NORTH MAS F
South Badley MA7BI /1
Cy .o Failure to possess a current edition of the Massachusetts
r irto�s -State Building Code is cause for revocation of this tense.
9 .�,b Expiration
Commissioner 69/29//2017 Fm DPSbce.singinformationvisie wwwMass.Gov/UK
L ':T
tl= Office of Consumer Affairs and Busi ss Reg-lation
'
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
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.
SCAT 0 20M-05:11 9 Address ❑ Renewal 9 Employment 9 Lost Card
-74e t,,,,,,,,,,,,,,er/tA Fa.f{urbu,:e/f,
a—' Office orConsumer Affairs&Business Regulation10SLicense or registration valid for individul use only
before the expiration date. If found return to:
OME IMPROVEMENT CONTRACTOR
! Yxpiration: 6egistratlon: 175982 Type: Office of Consumer Affairs and Business Regulation
E27/2017LLC
. 10 Park Plaza-Suite 5170
Boston,MA 02116
AMERICAN INSTALLATIONS,LEC.
WESLEY COUTURE
130 COLLEGE SWEET SUITE 100 .„ i ,..t _ zy
SOUTH HADLEY, MA 01075 Undersecretary N• valid without signature