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30A-026 34 LEXINGTON AVE BP-2016-1558 GIS it: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A-026 CITY OF NORTHAMPTON Lot:-OQI PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Build(ng DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:windows replaced BUILDING PERMIT Permit# BP-2016-1558 Project# JS-2016-002663 Est.Cost: $1415.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: const.Class contractor: License: Use Group; AMERICAN INSTALLATIONS LLC 175982 Lot Size(sq.It): 26136.00 Owner: PAVLOVICH JOSEPH M Ne BARBARA T Zoning:UIS,B(100 / Applicant: AMERICAN INSTALLATIONS LLC AT: 34 LEXINGTON AVE 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;REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector f Wiring IXP.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House#! Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: 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 6/29/20160:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner pepattment use'only City of Northampton Status of Permit: Budding Department Curb Cut@avewaay Permit 212 Main Street Sewer/SepbcAvagabllity Room 100 WaterMeB'AvallsbWity Northampton, MA 01060 TWOSets of Structural Plans phone 413.587-1240 Fax 413-587-1272 PtotISlte Pians Omer Specify ...... 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 34 Lexington Avenue Map Lot Unit Northampton, MA 01060 Zone Overlay District Elan St.D(Mfict. - CS Dlntrtct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Joseph ea Barbara Pavlovlch Same Name(Pant) Cwfera Ad rens: 413- 454 See attached - Telephone Signature 2.2 Authorized Math American Installations 130 College St., Ste 100 South Hadley,MA 01075 Name(Pntd) - Curent Migkg Address: American Installations 413-552-0200 Signature Telephone .. SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3415.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) S.Fire Protection f� 6. Total=(1 +2+3+4+5) .541SUU Check Number 49(? �( (,[/� This Section For Official Use OM Building Permit Number: Date — issued: Signature: Balding CommIsslonedlespector of Bulldogs pate r Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size I Frontage I J I Setbacks Front Side L: I R:I I L: R: I E-1 Rear �I L J Building Height I 1 I I Bldg.Square Footage LJ % 1 Open Space Footage % I (Lot arca area bldg&paved I)___Iparkmg) ft of Parking Spaces 1---1 Fill: �Q (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O 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 1 I Page and/or Document'L- B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O 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(clearing,grading,excavation,orfilfmg)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. A SECTION k DESCRIPTION OF PROPOSED WORK(check all applicable) New House [l Addftion 0 Replacement Windows AReration(s) D Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs (CJ Decks [IJ Siding(CO Other Brief Description of Proposed Work Replacement windows (J.29 Alteration of existing bedroom Yes,No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Mt.if New house and or addition to existing housing,complete the following: a. Use of building;One Family Two Family Other b. Number of rooms In each Sarney unit Number of Bathrooms c. Is them a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of eachT g. Energy Conservation Compliance.� Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes _No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or ceflar floor below finished grade It. WW building conform to the Building and Zoning regulations? Yes No. i. Septic Tank_ City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. Joseph 6-Barbara Pavlovich as owner of the subject Rws,ty hereby authorize American Installations to act on my behalf,in all matters relative to work authorized by this building permit application. See attached 6-28-16 SlgriaWre of Owner Date n_ I American Installations as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are bun and accurate,to the best of my knovtiodge and belief,. Signed under the pains and penalties of perjury. American Installations Print Name American Installations 6-28-26 Signabae of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Wesley K. Couture 106178 License Number 130 College St., Ste 100 South Hadley, MA 01075 9/29/17 Address Expiration Date � 413-552-0200 Signature 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 Iladley, MA 01075 Telephone 413-552-0200 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,§25C(51) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide Ws affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes OI No 0 11. -Rome Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupiedDwelings of one(I) 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 structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildins 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 rci tuieeto 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 resp onsllbility 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 The Commonwealth of Massachusetts Department ofIndustrial Accidents itrtyIrl Office of Investigations sr ci SIP 1 Congress Street,Suite 100 Hihil_ Boston,MA 02114-2017 www massgov/din Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organirationdndividuaq: 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): LE I am a employer with 27 4. 0 I am a general contractor and I 6. ❑New construction employees(full andtor part-time).* have hired the sub-contractors 2.❑ lam a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8, ❑Demolition workingfor me in anycapacity. employees and have workers' 9. 0 BuiIding addition [No workers'comp.insurance comp.insuree.t required.] 5. ❑ We area corporation and its 100 Electrical 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 MOL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13. Other W` - i Ind 0 employees. [No workers' comp.insurance required.] _ *Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractorsmust submit a new affidavit indicating such. iConuv:tors that check this box must attached an additional sheet showing the came of the sub-contractors and state whether or not those entities have employees. If the subcontredms have employees,they mug provide their notkets'comp.pokey number. I am an employer that Is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Guard Insurance Companies .. Policy#or Self-ins.s.Lic. #: URWCfi09917 Expiration Date: 09/04/2016 Job Site Address_ '4 t IS—net A i . City/State/Zip: S itt. _rue --4tIrt 1000 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 MOL 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. t I: as_.c• G . _:._1.: ,. 'i[. ,_.!_' Date: (a -rRa- Ir, Phone#: 9/.3-875i'1-ago° Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# 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#: ACORIO CERTIFICATE OF LIABILITY INSURANCE DAT 015 D 1YEY1 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 endoMment(s). �p� PRODUCER N lir Linda TamamiN Webber S Grinnell ailGx nth. (413)586-0111 No:14331546-6011 8 North King Street AITMEIESS:1powere@webberandgrinnell.COM INSURERS)AFFORDING COVERAGE NAIC Y Northampton. NA 01060 INSURERA Smployar's Nutnal Casualty,,,_. WOOER RRUMER a 3rmOCIARDJ00 GUARD .... American Installations, LLC INSURER C- Attn: Wee a Suzanne Couture INSURER 0: 130 College Street Suite 100 INSURERE: South Radley NA 01075 INSURER F: COVERAGES CERTIFICATE NUMBERS4aster 4-2015 REVISION NUMBER: THIS IS TO CERTIFY THAT YHE 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 WTO! 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. EA3 TYPE OFINSEIRANCE FF:IIT:jj'iia v'CAMBER I .!AlAU �:.? .Liu UOS fl CERIVERCt4L GENERAL II teaser' mcnoccusare CE 1,000,000 A IIID isgaminon n OCCUR DAMAGE RENIW 50,000 So3533216 9/4/2035 9/4/2016 MED EJ.P/Any one troncn) 10,000 III, PERSONALS ADV INJURY 1,000,000 GENE AGGREGATE POTRRNW APPLIES PER. GENERA/AGGREGATE 2,000,000 IQ POuCY TOE IOC PRODUCTS-COMP/OP 906 2,000,000 OTHER: AUTOMOBILE UA LJW ON SINGLE Mar 1,000,000 A ■AMT AVM SCORE INJURY We wow/ I=AL.OIN:ED AUTOS LED AUTOS 8 AUTOS 573535236 9!4/2035 916t2026 NAME(Floe ler} ©HIRED AUTOS z AWOS ED PROPERTY DAMERE U1(S (Pat ac leo PIP-Bat 8,000 X UMBRELLA MB OCCUR EACH OCCURRENCE $ 1,000,000 A ■ MESS MB CLAIMSAIADE AGGREGATE 5 1,000 000 DEO X REl£xf l$ 10,000 553535216 9/4/2015 2E4/2016 5 WORKERS COMPENSATION AND EMPLOYERS' urn' YIN 5 A MoB/YE FRx ANYPROPRIFIRPARn€R.EXECNPE EI EACH ACCIDENT 4 500,000 B CFFICEftWMNER EXCLUDES?: NIA IMantlnMy M NH) 1110060991I 9/4/2013 9/4/2016 EL DISEASE.EA EMPLOYEE 500,000 twos.M[TIONNNe .. CESc IPTIONOFOPEPATIONS Le 4a EL DISEASE-P(XJCY UMIT S 500,000, A Corancial Property 5A3535216 9/4/2015 91412016 edocine1.001, 20,000 dLemwest000 40,000 DESCRIPTOR OF OPERATIONS/LOCAIIONSI VEHICLES IACORDIDI,AdS, .I RemotaschtUUM.nay be alachetl Nmod yaw a mean Proof of Coverage, workers' Compensation policy includes clean code 5474 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ME EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR¢ID REPRESENTATIVE Kevin Joyce/LMP 1Z-Et- 01988-2014 2' " — ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD Mame and logo are registered marks of ACORD iNSD25fxnnn 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(991m3)of Construction Supeniior ear enclosed space. License:CS-106178 ,sees IjIE of WESLEY COUTIS'soliit '6r 166 NORTH MAHVN • �G South Hadley Mk-01 ,.., k 01 ) T j\/�/ Failure to possess a anent edition of the Massachusetts s n .State Building Code is cause for revocation of this license. 92.... _ . "inExpiration Commissioner 09/29/2017 For on licensing information visit www.Mass.Gov/UPS 9 dile Wow- 0 '1 II 0/ .11 1 4 .46 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: 6272017 Tat 265208 AMERICAN INSTALLATIONS, LLC. WESLEY COUTURE 130 COLLEGE STREET SUITE 100 SOUTH HADLEY, MA 01075 Update Address and return card.Mark reason for change. sin: c 201A 05/110 Address Q Renewal E Employment 9 Lost Card C91.`F „Wem/!L fS 6l 1, G,Jad Office of Consumer Affairs&Business Regulation License or registration valid for individul use only COME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Istration:Leg 175982 Type: Once of Consumer Affairs and Business Regulation Expiration: $272017. LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 AMERICAN INSTALLATIONS,LLG WESLEY COUTURE / _ 130 COLLEGE STREET SUITE 100 y„„— C/-✓fi/ SOUTH HADLEY MA 01075Undersecretary �_ N valid without signature