30C-017 (7) 497 BURTS PIT RD BP-2017-0239
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-Block:30C-017 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-0239
Project# JS-2017-000398
Est.Cost: $2826.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sci. ft.): 13982.76 Owner: TZOUMAKAS ANTIGONI P& DAVID F LIVELY
Zoning: SR(100)/ Applicant: AMERICAN INSTALLATIONS LLC
AT: 497 BURTS PIT RD
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200
SOUTH HADLEYMA01075 ISSUED ON:8/25/2016 0:00:00
TO PERFORM THE FOLLOWING WORK: Attic and basement air sealing and insulation
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House W 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 Sionature: FeeTvoe:
Date Paid: Amount:
Building 8/25/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
1 ,- 0915
RECSlVNU Depab 2 fWep dl
City of Northampton Stab PenNt
2 ���� Building Department can CnuDdrvexaypenat
AUG 2 212 Main Street $eged$epdcavailabflity
Room 100 WErdtNJes AvauaWhy
DEFT OF SOLO%o wsPFcnuas Northampton,MA 01060 Tr(g orsutt dei Plegs
NOWHA:PlOn MA C101100
ptitxTe 413587-1240 Feu 413597 1272 �WI}$Re Pests
GtlimriSpedfyv: . .
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOUSH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATKKN
1.1 ProgerlvAddress: This section to be completed by office
497 Busts Pit Road Map Lot Unit.
Zone Overlay District
elm St District - CB Dineen
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
David Lively 497 BurtsPPiitt Road
Name S'dtt) 4133--8-88 09 9
See attached 7818/3710/10
Speen
3.2 Authorked bent;
American Installations 130 College St.,Ste 100 South Hadley,MA 01075
Nene(RIM) t,
- •
/ ' OnMalkin
American installations (,Li(4)(4) l��. 413-552-0200
Sipet n, Telephone
SECTION 3•ESTIMATED CONSTRUCTION COSTS I
Item Estimated Cost(Cohn)lobe OMdei Use Only
completed by permit applicant
1. Building $2,826 (a)Building Permit Fee
2. Elect/NW (13)Estimated Total Cost of
Conbuotlan tan EN
3. Plumbing Building Permit Fee
4. MecbencaI(HVAC)
5.Fire PmkGkn
O. TotaSQ(1+2+3+4+5) $2,826 Chet*Number
This Section For Official Use Only
Date
Boding Penns Number Jib t. -.
, . . may.
Z[1 Signatae: ((( G /�
SuMing CommlasionenInspeent of Buildings Date
Section 4. ZONING an Information Aust Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Tido column to be filled ta by
augdmg Department
Lot Size
Frontage I I
Setbacks Front
Side L: I R L.0 RC I I
Rear I I
Building Height i I I
Bldg.Square Footage % I I
Open Space Footage
(Lot area minus bldg&paved
parkin)
If of Parking Spaces r—I I I
Fill:
(volume al.oaca)
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:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book I Pagel I and/or Document Ai
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T 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 O ,Date Issued: I
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 O NO O
IF YES,describe size, type and location: •
E. Wig the construction activity disturb(cleating,Wading,excavation,or Idling)overt acre or Is it ped of a wnunon plan
that will disturb over t acre? YES NO 0
IF YES,then a Northampton Storm Water Management Permtfrom the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK(cheek ail apogcable)
New House 0 Addition 0 Replacement Windows ASeratlon(ej D Roofing 0
Or Doors 0
Accessory Bldg. ri Demolition 0 New Signs (CI Decks IO Siding10j inert
Biota(
Work: Ata f�ic and asement insulation and air sealing throughout
Alteration of misting bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating wt fished basement Yes �No
Plans Method Rog -Sheet
_ . . .u ._ _ - . .
ge.If�New house BndMF eddldon.W.ezistirighouBirtG..comDlete thefoilowinq:
a. Use of bug64q:One Featly Two Family Other
b. Number of roans In sack telly unit Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of dudes?
f. Method of hearing? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Massched Energy Compliance Joan attached?
h. Typed construction
I. M construction within 100 A ofwetlands? Yes ____No. Is construction vain 100 yr. loodpl n Yes No
j Depth of basement or cellar floor below finished grade
k.
WE building conform to the Balding and Zoning regulations? Yes No.
I. Septic TankCity Sewer Private ween City water Supply_,_
SECTION Ta-OWNER AUTHORRATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
David Lively as Ovmerdthe subject
proferty
hereby authorize American Installations
to ad on my behetf,Mal matters relative to work authorized by this buildkO pemdtappiication.
See Attached &-12-16
SIgMWe d Owner Data
I, American Installations as Chimer/Authorized
Agent hereby declare that the statements and information on the foregoing application are nue and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties ofpejury.
American Installations
Ate
American Installations
Slgrabs,dOsnertAgera Date
SECTION 8-CONSTRUCTIONSERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Namm plttunaeNolder: Wesley K. Couture 106178
Ucens.PbnMinter
130 College St,Ste 100 South Hadley,MA 01075 9/29/17
Address !/ EryBetbn pate
(.✓..A1._- I� C 413-552-0200
Signature Telephone
9.Registered-Nano hinirMiement Contactor , Not Applicable
Wesley Couture 175982
CWmnnwName Registration Number
American Installations 6/27/17
Address Expiration Dade
130 College St., Ste 100 South Hadley,MA 01075 Telephone 413-552-0200
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MAJ..e.152,§25C(8))
Workers Compensation Insurance affidavit most be completed and submitted with This application.Falureto provide Mis affidavit wit resua
In the denial retie issuance of the bulldog permit.
Signed Affidavit Attached Yes._..,. Al No ❑
Rome Owner Exemption
The current exemption for"bomeovmers"was extended to include Owner-occupied Pavanes of one(1) or taro(2)6milies
and to allow such homeowner to engage an individual.fix bitt who does not possess a license,provided thattbe owner ash
as serwevber.CMRTM, Mxth Edifies Sector 188,33.1.
Pefdntiob of Homeowner:Person(a)who own a parcel of land on whichbelshe resides or intends to reside,on which them
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 turns than one bone In a two-year period shat)not be considered a hon owner.
Such liomeownat'shall submit to the Building Official,on a form acceptable to the Building Official.that he/she shall be
As acting Construction Supervisor your presence on ibe job site will be required tom time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with roG.,.we to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Amotaed,von may be Bahia forperson(s)
you bite to perform work for you eater this permit
The undersigned'homeowner"certifies and assumes responsibility Pmcompliance.with the State Building Code,City of
Northampton Ordinances,State and Local Zoning taws and State ofMassachusens General Laws Annotated.
Homeowner Signature
City of Northampton
$F ?q,... Massachusettss- s
s`\ ,�pa
Y r=Raana r O£ auILOTAG IAsprCTIOAa \1 JC
212 Main street • Municipal Building 4 e i
9onthupton, Mt 01460 `i. C
497 Burts Pit Road
Property Address:
Contractor
Name: American Installations
Address: 130 College Street St& 100
City, State: South Hadley,MA
Phone: 43-552-0200
Property Owns/
Name: llavid Lively
497 Burts Pit Road
Address:
Florence,MA
City, State:
I, American Installations (contractor)attest and affirm that the building I intend to
kisulate 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 /�CD
(/‘).„ N. I —�
Date
08-12-16
cam
i/Fr;• ww.ArasWLcen:imlabin urea
BBEt
AAA CSa& 0urea
AAA Iw #2775:82
L ATA Fegktm3ronX 225981
American Installations
130 Collge Street Suite 100,3oKp WGky,MA O10]9.Office:(41J)552-0200 Fac(4131352-022•Email:1upporwAmerlunlptMatIM,mm
Lively,David 5/31/2016
run
497 Baits Pit Road Florence MA 01062
1`.8,413-885-8909 dlively@gmail.com cam. m
int
434214 u..n 16-0915
Quantity Unit Unit Cost Total
Air Sealing
AIR SEALING 1D man hour $ 8500 $ 85000
Total Air Sealing Incentive $ 850.00
Weathedrattan'
FLAT-8"OPEN R-28 1,015 sqft $ 1.37 $ 1,390.55
HATCH S€AI.&INSULATE each $ 60.00 $ 60.00
CRAWLSPACE WALL RIO RIGID INSL al soft $ 330 $ 284.90
DAMMING R-38 linear ft $ /OS an
DOOR WEATHERSTRIPPING Wf SWEEP EWE each a 5 150.00
ERMA
REMOVE INSULATION sqft
$ 0.75
Total lnren[Mzetl Weatherization $ 1p18.25
Total Non-incentivized Weatherization $ 57,75
Total Project $ 2,826,00
Total Utility Contribution $ 2,288.69
Total Customer Contribution $ 53J311
WARRANTY:Amerbn Installations.l¢adI provide the!dove nxe l homeowner with 2 yew wn*manship wamanry.
Installations,tic hereby pm al aM lbm to compare the awe scope Mwrt In accordance wM time shwa specification%and al localand pare
buiH{reeohenn(or the Total Cunrx Woe furnish
M1nert,
ACCEPTANCE OF P8OPOSAt The above orkecsttK aomam TOTAL CONTRACT VALUE $ 531.31`�
yumiers tre odo wrsceprsan6arz 6mebynt wplb4vousrc Y �kC 37I
to starizof tom ntl baespecified.
upon ComlAtr43 down prior Down Payment $ 178.00
0,0 start of wahpntl balance due upon Cpm ktlbn
r Balance Due Upon Completion $ 358.31
OA
1171) t J tli'1J iJ�ir ' '?% • 7_2
Wyatt Couture ��
l Km
RIMED Srm.,w-.mnaacmm,trmwuro' e a.:ttt.t FED, 'NU.,.;;u�CTw:II:Hli LM;.:roLTI,l;woo;::.rSOf DIESIMIINMASSAtarvellICAa,
The Commonwealth of Massachusetts
Department oflndustrialAccidents
e 6l Office of Investigations
trerani.
I Congress Street,Suite 100
Boston,MA 01114-1017
:tn www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): American Installations, LIC
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:
1 6. of project(required):
�
I. Iam flemployer w 27 4.ith ❑ am a general contractor and l
employees(full and/or part-time)." have hired the sub-contractors 6. ❑New construction
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers'comp.insurance comp.insurance? 9. ❑Building addition
required.] 5. 0 We are a corporation and its 10.0 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 MGL 120 Roof repairs
insurance required.]t c. 152,§1(4),and we have no insulation
employees. [No workers' 13.�Other
comp.insurance required]_
*Any applicant that cheeks box#1 must also till out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tComactors that cheek this box must attached an additions sheet showing the name ofthe sub-contractors and state whether or not those entities have
employees. Ifthe subwntra io s have employees,they must provide their workers'comp.policy 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. Lic.#: URWC609917 11 Expiration Date: 09/04/2016
Job Site Address: yC _(jn4s 9:4' RODE City/State/Zip: C.1 OrOce't PAA. °106'
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.
I do hereby ccera&under the pains and_,penalties of perjury that the information provided above is true and( correct.
Sign ature�.Llrrrt41 9 6'i7/.ft(/7.P - Date: —t7`\to
Phone#:/ 4%,S-552^Om'toO
Offrcial use only. Do not write In this area,to be completed by city or town official.
City or Town: PermitILicense#
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#:
/1e
A`omo CERTIFICATE OF LIABILITY INSURANCE DATE
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. N 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 CCpNKETAM Linda Powers
Webber & Grinnell PHONE (413)586-0111 FAX Nu.(413)586-6481
8 North King Street n4tAIL e:1powers@webberandgrinnell.con
Northampton ML 01060 'MEDIUMS)AFFORDING COVERAGE NAIC/I
puma Rmployers Mutual Casualty
INSURED NSURERB AaC l.RD/8B GUARD
American Installations, LLC INSURER C:
Attn: Nes 6 Suzanne Couture INSURER*:
130 College Street Suite 100
INSURER E:
South Hadley !Lk 01075 INSURER F:
COVERAGES CERTIFICATE NUMBERNaster 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.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR LICY EVE POLICY UP
LTR TYPE OF INSURANCE ,N n POLICY NUMBER INWOOOHYYY) IMM/DM'YYYI UNITS
X COMMERCIAL GENERALWBNRY
EACH OCCURRENCE 1,000,000
A X CLAIMS-MADE OCCUR DAMANE TO RENTED 50,000
PREMISES(Ea®nrol
503535216 9/4/2015 9/4/2016 MEDEXP(Any me person) 10,000
—
PERSONAL 8ADV INJURY 1,000,000
GENT AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE 2,000,000
X POLICY jECT 17 LCC PRODUCTS•COMP/PAGG 2,000,000
OTHER:
AUTOMOBILE LAMVIY COMBINED SINGLE LIMIT 1,000,000
A ANY AUTO BODILY INJURY(Pet person)
�
OWNED R SCHEDULEDTO5E3535216 9/4/2015 9/4/2016 BODILY INJURY(PremMq
X HIRED AUTOS R AUTOS Ira Isaidecg) E ...-.
NP-Rase 9,000
X UMBRELLA UAB OCCUR EACH OCCURRENCE 5 1,000,000
A EXCESS WB CIAIMSMADE AGGREGATE 5 1,000,000
OED X RETENTION S 10,000 503535216 9/4/2015 9/4/2016
!WORKERS COMPENSATION PER 0114-
AND
TH-AND EMPLOYERS LIABILITY T/N STATUTE ER
ANY PROPRIETdicARRENEXECUTNE 1 1 EL EACH ACCIDENT S 500,000
OFFIGEWMEMBER EXCLUDED? N/A
B
IMYYandatory N E
Nm UPMC609917 9/4/2015 9/4/2016 L DISEASE-EA EMPLOYEES 500,000
DESCRIPcndesbe under
TION OF OPERATIONS SYbx EL DISEASE-PQJCY LIMIT 5 500,000
A Commercial Property SA3535216 9/4/2015 9/4/2016 deduce[,51.800 20,000
deduaNe SIPCO 40,000
DESCRIPTION OF OPEMTIONS/LOCATIONS/VEHICLES(ACORN hit Addftkne Remarks Schedule,maybe emceed N more apace M fawn*
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, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTOIaZE)REPRESENTATIVE
Kevin Joyce/LMP ��
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INSO25nmanI
irMassachusetts-Department of Public Safety Unrestricted-Buildings of any use group which
Board of Building Regulations and Standards contain less than 35,000 cubic feet(99Im1)of
CLm[n e:C 51061711 uucu6d space. ,
License:CS-006170r
WESLEY COUTUJ e t.` & .�
166 NORTH MAINil
South Rocky 110.701Failureto possess a currentedition of the Massachusetts
il v-' rriv IA - State Building Code is cause for revocation of this license.
Imo. ., Expiration
Commissioner 09/29/2017 for DPS Licensing information woe www.Mass.sov/OPS
glite 3�\ r
nisi-- Office of Consumer Affairs and Busr ss Regi lation
hf 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 175982
__.__ Type: LLC
Expiration: 6/27/2017 Tr# 265206
AMERICAN INSTALLATIONS, LLC. -
WESLEY COUTURE
130 COLLEGE STREET SUITE 100
SOUTH HADLEY, MA 01075
Update Address and return card.Mark reason for change.
SCA 201.1 ono E Address 0 Renewal E Employment ❑ Lost Card
vibe Y' d,wecr/!/ /n i(.. . Au/A
Office ofCnsu Affairs&Busess Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egnlmhon: 175862
2E
Type: Once of Consumer Affairs and Business Regulation
Expiration: SG27R017 LLC 10 Park Plaza-Suite 5170
Boston,MA 02116
AMERICAN INSTALLATIONS,LLG
r
WESLEY COUTURE ` i
130 COLLEGE STREET:SUITE 100 r r.i.,<,.�
SOUTH HADLEY,MA 01 WS - I C —r
Undersecretary N valid without signature