Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
23B-054 (2)
40 BERKSHIRE TER BP-2016-1551 6154: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 23B-054 CITY OF NORTHAMPTON Lot:-OW i Peimd: Building Category; INSULATION BUILDING PERMIT Permit BP-2016-1551 Protect# _JS-2016-002645 Est.Cost:$260Q.99 _ee: 361,00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 tat Size(tq. ft.): 10890.00 Owner: SISLER LYNN& MARK ERBA Zoning:LIMO0(13i Applicant: AMERICAN INSTALLATIONS LLC AT: 40 BERKSHIRE TER Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 Liability SOUTH HADLEYMA01075 ISS LIED ON:6/24/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:ATTIC AND 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 a 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: FeeTvpe: Date Paid: Amount: Building 6x29,20160:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck-Building Commissioner File 4 BP-2016-1552 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200 PROPERTY LOCATION 40 BERKSHIRE TER MAP 236 PARCEL 054 001,,,ZONE UR6(I0011 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM/ FILLED OUT Fee Paid 4a tts3 -CO 5" ildine BuPermit Filledt out Fee Paid Typeof Construction: ATTIC AND BASEMENT INSULATION AIR SEALING THROUGHOUT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildine 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: r,{Rpproved_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 fid'—/K ure of Buil(Mg Of ficial 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, . 4:.14,�� _ 16-1001 'c% ) / Oapartment use dnh' 7 ` City of Northampton Status of Permit / Building Department Curb CuUDnvev. y Pemdt 212 Main Street Sewerl5opticAvdlatifity Room 100 WaterMeii AvaSabaity Northampton, MA 01060 Two Sets of Structural Plans. phone 413-587-1240 Fax 413-587-1272 €iof/SIte'Plans , Other Spgd(f APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY UNELLING SECTION 1-SITE INFORMATION 1.1 PropertvAddress: This section to be completed by office 40 Berkshire Terrace Map Lot Unit. Florence,MA 01062 Zone Overlay District Elm St District_ 61116617161 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Lynn Sister d Mark Erba Same Name(Print) Current McRng Address: 404-680-9690 bSee attached - Telephone Signature Q 2.2 Authorized Ment American Installations 130 College St.,Ste 100 South Hadley, MA 01075 't1 Name(Print) - Current Mang Address: American Installations 413-552-0200 - Signature Teiepheee SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be 06adm Use Only completed by ponnit applicant 1. Building 2600.99 (a)Building Permit Fee I ___ 2. Electrical (b)Estimated Total Cost of Constudf on from(S) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) S.Pita Protection 6. Total=(1+2+3+4+5) 2600.99 Check Number afel j 41-05-- This Section For Official Use Only Building Permit Number. Date Signature: Building CommIssioneranspeotorof Bu lbws Date Section 4. ZONING All Nervation Must Be Co pets&Permit Can Be DeNed Due To incomplete Nomatbo E i ting Proposed Required by Zoning This column to be Baca in by Buadmg Dyummr Lot Silt L.. 1 I__ 1 Frontage r _ 1 I I Setbacks Front I LKIg L1 I it I iA . 1 RA--1 r-1 TT Rear il ; I r-1 Building Height I I Bldg.Square Footage % I I I Open Space Footage w I I / r I �� (tot minus bldg g& parkieW N of Puking Spaces i I I J i I Fill: r (e ... -� A. Has a Special PermitNariance/Finding ever been issued for/on the site? NO 0 DONT KNOW O 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 I1 Page and/or Document 91 I B. Does the site contain a brook,body of water or wetlands? NO Q DOtff KNOW 0 YES 0 _ — -- Or LES, Das a per no(Aeon a Deedm de adaarledtiiolntyte Conservation Commitsient Needs to be obtained O Obtained O , Date Issued C. Do any signs exist on the property? YES O NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property 7 YES O NO 0 IF YES, describe size, type and loralidn: E. Wit the construction activity disturb(dewing,grading,excavation,or Slang)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 Siam Water Management Perma from the DPW is required. SECTION 5-DESCRIPTION QF PROPOSED WORK(check all applicable) New House 0 Addition ❑ Replacement Windows Alteration(s) 0 Roofing 0 Or Doom C) Accessory Bldg. 0 Demolition 0 New Signs [C) Decks @ Siding OM] Other(Flg Brief DoscripfJon a D rgcced Work: Attic arra asement 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 Roll -Sheet Se.If New house and of addition to existing housing..completD 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 9. Energy Conservation Compliance. Massobeck 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 rear 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 APPLES FOR BUILDING PERMIT ... .. . .. _. i as gamer oflhe subject ..i."•.-fifty-Sisier'..t=;t3a3inr7ci"'.. ._ . property hereby authorhe American Installations to act on my behalf,in an matters relative to work authorized by this building permit aCcacation. 6-22-16 See attached gabs Signature of Omer as OwnerlAulhorized I, American Installations ration are buy and accurate,to the besta£my knowledge Agent herebydedare that the statements and information on the foregoing app8 and belief. Signed under the pains and penalties of perjury. American Installations Print Name 6-22-16 American Installations Date Signatum of OwnertAgent • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name cit License Holder: Wesley K. Couture 106178 License Number 130 College St., Ste 100 South Hadley, MA 01075 9/29/17 Address Expiration Date n 50- —CL 413-552-0200 mnatwe Telephone 9.Registered Home Improvement Contractor: _ - Not Applicable ❑ Wesley Couture 175982 Company Name Registration Number American Installations 6/27/17 Address Expiration Date 130 College St., Ste 100 South Radley, 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 m the denial of the issuance of the building permit. Signed Affidavit Attached Yes IN 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 Edition 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 starching.A person who constructs more than one home in a two-year period shat)not be considered a homeowner. nom�WeOC-span moron toute •„ NOP II a -;r",on a orm accepts:I to Buildin he/she res p°ague f all such kn .t mit SOlfinial,that he/she eballbe • -medn� N bund• As acting Construct Snoervlsp your presence on the job site willbe completion of the work for which this permit is issued. required from time to time,during and upon 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 6 name for person(s) you hire to perform work for you under this permit The undersigned"homeowner"certifies and assumes responsibility forcompliance with ibe StateiCode,City of Northampton Ordinances,State and Local Zoning Laws and State ofMassachusems General Laws BAnnuildotangted. Homeowner Signature City of Northampton Massachusetts C.. et .c If :1'. - s D£FRa8; 29B^P OF anZT.DZAC INSPECTIOBS 5\ 212 Main Btraat a Mmicipai Building L+w 10_..._ Northampton, Hs 01060 �"t0 Property Address: 40 Berkshire Terrace Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley, MA Phone: 43-552-0200 Property Owner Name: Lynn Sisler&Mark Erba Address: 40 Berkshire Terrace 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 `F Date 6-2216 itbw.AmonranlnafmimmnE.cnm BBB t wwLicensed&insured MA(SL 4:106178 MA Registration A 175982 American Installations 130 Coati Street Suite 100,South l4dley,MA01075•Office-..1413j 55111200 fax:013)55141202•Ensin gpontssNrcffumnstaiiations.com Sisler&Erba,Lynn&Mark 5/3142016 737 tr_ 40 Berkshire Terrace Florence MA 01062 rta+mAl fun i e".i ram 4046809690 lasisler@gmail.com owelr 433039 �n�l 16-1001 (kb WI w.105 Quantity Unit Unit Cost Total AkSealing AIR SEALING 8'man hour I $ 85.00 L$ 680.00 Total Air Sealing incentive $ 680.00 Weatherization FLAT 9"OPEN R-32 800 sgft $ 1.43 $ 1,144.00 DAMMING R-38 12 linear ft $ 2.05 $ 24.60 THERMADOME Wag WOOD BUILD-UP 1 each $ 237.65 $ 237,65 12"X12"VINYL GABLE VENT 2 each $ 114.00 $ 228.00 PLASTIC GROUND COVER 262 sqft $ 0.77 $ 201.74 TEMP ACCESSTHRU DRYWALL 1 each $ 85.00 $ 85,00 Total Incentivized Weatherization $ 1,920.99 Total Project $ 2,600.99 Total Utility Contribution $ 2,S20.74 Total Customer Contribution $ 480,25 WARRANTY.AmerranIn:mrhnom,uc will provide the above stated homeowner weh a t year whmarehrp wananry. ATmican i,s':eahrne,!IC hereby proposes to furnish ae nnte:f aro tabor dodempiete theabode wade of work in accordance wee the above apeuhroden and err pear and dine eurwsm regm etons for the Total contractValue as slated herein. ACCEPTANCE OF PROPOSAL.The above Prices,specs eafions and TOTAL CONTRACT VALUE= $ 480.25 commons are satisfactory and am hereby accepted.You are authorized to do work as specified,Payment will be 1/3 down prior to Down Payment= $ 160.00 n sten of work,and balance due upon Completion. p OO / Balance Due Upon Completion= $ 320.25 01 -4 5331/2016 .445a.n.4"4w. <-4— ? 1 5/3016 VA(Ekttir,15 COMICS:, nus PQA{VP 71i mAe<w.team-.ANO Maomararaprrtum.awt[w,w[rea E„ ARRtorPu/ `,'/Ru4I'',AmunePwer[n-;/wNawraowwrtuws.a[uuu,rwrsnpowwru n.or"ex�"rartorrnuuwu',ensOR„ryNmic„fxao THIS AGREEMENT IS COMPOSED OP THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL ISE 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 RUINED,'TO AL APPROPRIATE LAWS,BEGUTATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS. THE FOLLOWING TERMS AND CONDTIONSAtSO APPLY 1.IRIS AGREEMENT IS SUBJECT TO THE APPROVAL Of A MANAGER OP THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION. 2.SHOULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL RE ADDED FROM THE DATE THEREOF ATA RATE OF ONE AND ONE-HALF(1-1/2)PERCENT PER MONTH. (184 PER ANNUM)WITH A MINIMUM CHARGE OF 5200 PER MONTH.AND IF PLACED IN THE HANDS OF AN ATTORNEY OR COLLECTION AGENCY FOR COLLECTION.ALL.ATTORNEYS'FEE$, EXPENSES AND COSTS OF COLLECTION SHALL OE PAID BY THE WENT.IN ADDITION.CONY UNDERSTANDS THAT W FAILING TO PAY ACCORCYNG TO THE ABOVE TERMS,COMPANY MAY HAVE THE RIGHT TO A LER)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 CLIENT FOR COMPLETION OF ALL WORK DESCRIBED IN ATIMELY AND WORKMANLIKE MANNER 5,ALL WARRANTIES f9R EQUIPMENT AND PRODUCTS SUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS OF SUCH EQUIPMENT AND PRODUCTS-NYDER SUCH MANUFACTURER'S WARRANTIES,THE CLIENT MAY BE REQUIRED To REGISTER OR MAIL INA WARRANTY CARO OR OTHER EVIDENCE OF OWNERSHIP AND USE OF NCH 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 ADD@ONAL EXPENSES,PREMIUMS OR COST SNAIL BE ADDED TO THE TOTAL AGREEMENT AMOUNT. 2.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 SDIPY DUE TO THF COMPANY'S NEGLIGENCE, S.DURING ME 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 APPROPRIATEACTION TO PROTECT AREAS OF WORK, e THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS.E.G.W000 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 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 PROBLEMIS)ON A TIME AND MATERIAL BASIS.CLIENT AGREES THAT SUCH CONDITIONS ARE UNAVOIDABLE BY THE COMPANY AND SHALL NOT BE CONSIDERED A VIOLATION OF NEE AGREEMENT AND THAT DUE TO THESE CONDITIONSTHE DURATION OF THE WORN AND SCHEDULED DATE OF COMPLETION MAY VIPERFROM THAT AGREED UPON IF APPLVARIT UNDER-ORS AGREEMENT. 10.IKE COMPANY IS NOT RESPONSIBLE,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES,IMO/DING BUT NOT LIMPED TO MOLD GROWTH,ARISING FROM THE PERFORMANCE OF AIR SEALING WORK BY THE COMPANY AS A RESULT OF ANY KNOWN DR 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 AFTERTHE PERFORMANCE OF WORK BY THE COMPANY. U.REPLACEMENT OF DETERIORATED DEWNG,FASOA BOARDS.ROOF DUCKS,VENTILATORS.FLASHING,PASHERS.JOISTS,INSULATION OR OTNER 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,DR DAMAGE TO PLANTS OR SHRUBBERY.IF EXCESSIVE DAMAGE IS CAUSED BY COMPANY.COMPANY WILL REPAIR OR REPLACE DAMAGED AREA ONLY AT OOMPANYS 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 OFVRIBEO IN THIS AGREEMENT CAUSED BY INIYULATORY 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. IT.THIS AGREEMENT CANNOT BE CANCELLED WITHCLT THE MUTUAL WRTTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN. IR.THIS AGREEMENT,AND ANY WARRANTY(5)PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY OR WITIT THE WRITTEN PERMISSIONOF 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 PE LIABLE FOR DAMAGES FOR THE GREATER OF THE COMPANY'S ACTUAL DAMAGES OR25%OF THE AGREEMENT FOR RESTOCKING PEE. 20.ANY CHANGES TO MATERIALS BY THE CLIENT HIRANO,STYLE,COLOR,ETC.)AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT IN A 5%RE-STOCKING FEE RASED ON THE COSTOF SAID MATERIALS, 21 ORS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO PRIOR TO WHICH TIME IT SHALL BE DEEMED APROPOSAL.THE COMPANY RESERVES THE RIGHT 10 REVOKE THIS PROPOSAL 90 DAYS FROM DATE IT IS EXECUTED BY THE COMPANY IF IT IS NT EARLIER EXECUSE9 RY THE CLIENT AND THE REQUIRED DOWN PAYMENT RECEIVED PRIOR TO THE EXPIRATION OF SUCH 90 DAY PERIOD,AFTER 50 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 Al SUCH TME. 22.IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCEOIIUY OF THE REMAINING PROVISIONS OF THIS AGREEMENT SHALL NOT BE AFFECIED'THEREBY. 25,ARBI'TRATION:INTHE 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 MATTERINTOARBRRATKKI BEFORE AN INDEPENDENT ARBITRATORASSIGNEO BY WE AMERICAN ARBITRATION.SSOCIATION TO RESOLVE THEIR DISPUTE. N.ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM(I E.MASS SAVER)15 SUBJECT TO THE AVAILABILITY OF QUALIFYING STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTILITY PROGRAM IS DISCW NTINUED.FURTHERMORE.THE TERMS AND CONDITIONS OF STATE SPONSERED UTILITY PROGRAMS MAYBE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE. 25.AMERICAN INSTALLERS,TLC IS NOT AN AGENT OF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASSSAVER ENERGY PROGRAM, 26,CLIENT IS REPSONSIBLE FOR THE PAYMENT OF ANY ANO ALL FEDERAL,STATE.OR LOCAL.TAXES THAT ARE APPLICABLE TO THIS AGREEMENT. The Commonwealth of Massachusetts Department of Industrial Accidents et Office of Investigations • : € ;r= _� A ! Congress Street, Suite 100 =% ar '. Boston,MA 02114-2077 �``•�'' www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nae u(Business/Organization/Individual): American Installations, LLC m (Business/Organization/Individual): Address: 130 College Street, Suite 100 City/State/Zip: South Hadley, MA 01075 Phone#: 413552.0200 Are you an employer? Check the appropriate box Type of project(required): 1,111 I am a employer with 27 4, ❑ I am a general contractor and I employees(full and/or part-time).* hive hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance? 9. © Builtling addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 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, 4I(4),and we have no Insulation employees. [No workers' 13.®Odor comp. insurance required.] 'Any applicant that checks teal must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit ads WWavit Indicating they am doing W work and then hire outside mouactorm st submit a new affidavit indicating such. tcontracton that chock this box must attached an additional shat showing the name of the sub-coatracton and state whether or not Mose inti shave cmployea If the sub-cnwnm,have employees,they oust provide their .eskers'camp.polity number. I am an employer that is providing workers'compensation Insurance for my employees Below is the polity and job site information. Insurance Company Name: Guard Insurance Companies Policy#or Self-ins. ��Lic. #: URWC6099177 Expiration Date: /09//04/2016 p-y Job Site Address: ` 3 �,1 ► I'I T��`, City/State/Zip: hC Xiff. � Oa O Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL 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 5250.00 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 ccDertify under the pains and penalties of perjury that the information provided above Letrue and- correct Signature:y(XH w 9 (%-f/./.l .' Date: Lo-(-) 1Io Phone#t y/.3-S,5:3-°Roo Official use on Do not write in this area,to be completed I ty. by city or town official. City or Towo: y�Permit/License # Lining Authority(circle one): I.Board of Health 2.Building Department 3.Cityffowv Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: -~TM ACCORO CERTIFICATE OF LIABILITY INSURANCE I DArElwuOcurrrl] 9/412015 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, TNS CLIO WICATE 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 ADDTiONAL INSURED,the polcy(ies)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of Ole 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 G Tam Linda Powers Robber 6 Grinnell NP F,y; (413)586-0111 (A%It Ne 1,14131586-6401 8 North King Street 7 it y paEselpowerepwebberandgrinnell.cont astatonS)&FORUMM COVERAGE NAICE _ Northampton MA 01060 MSNRERAPAployere Mutual Casualty INSURED INSURER a AIIGHARD/BH GUARD American Installations, LW INSURER C: Attn: Nae A Suzanne Couture INSURER p: 130 College Street Suite 100 MSIRtERE: South Nadley NA 01075 IMPAIRER F: COVERAGES CERTIFICATE NVMBER3teater 9-2015 REVISION NUMBER: 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 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -IR TYPE W INSURANCE WNL LOUD POLICY NUMIER HMWM W FFF IMMTW'/IYf1 LIMITS X COMMERCIAL GENERALWaRW EACH WI RRE*CE 1,000,000 A --XC CLAIMS-MADE I OCCUR PREMISES EAAGE TO NLNwnn *)en50,000 503535216 9/4/2015 9/4/2016 MEDEYP{My0em0 10,000I _ PERSONAL 6 ADV INJURY 1,000,000 GEMt AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE 2,000,000 (�� _....... .-.._ % �CYI IJECf F-1 16C PROnIICIS,WMPiOP AGO 2,000,000 OTHER: AUTOMOBILE WROTH B 3COOMSINGLE LIMI_ 1,000,000 1. A ANY AUTO BCULY INJURY IPer 0770,7 �� ED A AUTOS LED 5E3E35216 9/4/2015 9/4/2016 GODLY INJURY(Per NOON* X HARED AUTOSR N�SYONYO P ERE MAGE _ --- AUTOS IP umeure BP-Nage 9,000 R UMBRELLA OAS _OCCUR EACH OCCURRENCE S 1,000,000 A EXCESSUAB CLAMS-MADE AGGREGATE _ S 1600%000 DED I X RETENTIONS 10,000 5,73035216 9/4/2015 9/4/2016 �T $ MAXIMCOMPENSMTOI . PTH. AND EMPLOYERSLAMM ANY AFY YETreCRFATI NNEREXECUTIVE YtMNtA f5T"TVfpEL EACH ACCIDENT $ 500,000 HR EXCLUDED? 1D {WMMcfl3 NI Wm.604917 9/412015 9/4/2016 EL g5EASE EX EMPLOYEE S 500,000 Pyry eluate CE SCRIPTIONOP OPERATIONS EL,DISEASE POLICY LIMIT S 500,000 A Commercial Property $x36962/6 9/4/2015 9/4/2016 GHLASONS1,000 20,600 Mdx4Ma61103 40,000 I OESCRJPDW1 OF OPERATIONS!LCCANONStVBMGtES UWnD RH,Ad4Rbne Kart SAIa 4,may tie SC tad N Awe apace krtgeM) Proof of Coverage. Workers' Compensation policy includes class rads 5474 CERTIFICATE HOLDER CANOE!!ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RSPRESENTATNE �J Kevin Joyce/LMP ' 2-C " ID 1988-2014 A utas CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS02Sornan eMassachusetts-Department of Public Safety Unrestricted-Buildings of any use group which Board of Building Regulations and Standards contain less than 35,000 cubic feet(99 Im)of CL en ' nr enclosed space. License: CS-106178 WESLEY COOTUJ r E �' 166 NORTH MAp1 S1�I pe. South Hadley M01flli '7 VFailure to possess a current edition of the Massachusetts ss - State Building Code is cause for revocation of this license �-....-d�n. rr'u Expiration Commissioner 09/29/2017 car ofs licensing information mit www.Mass.4oe/ors I '1 1, 01 Alooadt14€46 :; 1 1:t[ Office of Consumer Affairs and Busi ss Reg'-lat on ,a 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 175982 Type: LLC Expiration: 6/27/2017 Tru 265208 AMERICAN INSTALLATIONS, LLC. ` ` WESLEY COUTURE 130 COLLEGE STREET SUITE 100 SOUTH HADLEY, MA 01075 -. Update Address and return card.Mark reason for change. SCA 0 20M 0501 - 0 Address El Renewal ❑ Employment El Lost Card 4.4e d .,,p,iA0 rne/fu Office of Consumer Affairsrs&Business Regulation License or registration valid for individul use only P OME IMPROVEMENT CONTRACTOR gbefore the expiration date. if found return to: istration: 175982Type: Office of Consumer Affairs and Business Regulation Expiration: 6/27/2417LLC 10 Park Playa-Sone 5170 Boston,MA 02116 AMERICAN INSTALLATION$,LLQ WESLEY COUTURE � A /r 130 COLLEGE STREET SUITE 100s{�'// SOUTH HADLEY,MA 01075" Undersecretary N valid without signature