36-031 (2) SI REDFORD DR BP-2017-0238
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map- Bock:36-031 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: INSULATION BUILDING PERMIT
Permax BP-2017-0238
Project# JS-2017-000397
Est.Cost: 3$30.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.clash Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq. ft.): 12980.88 Owner: KOCHAPSKI STANLEY HR&KATHLEEN S KOCHAPSKI
Zoning: Applicant: AMERICAN INSTALLATIONS LLC
AT: 81 REDFORD DR
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200
SOUTH HADLEYMA01075 ISSUED ON:8/25/2016 U: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 el 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 812512016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, fax:(41 3)587-1272
Louis Hasbrouck-Building Commissioner
Iii- 1154-1
F,_(37NrD DepaMalituae dNI
City of Northampton statue of Permit
AUG 2 2 2S Building Department Cu b C NOdv4eay Permit
212 Main Street $eryenaepticnvadetiHly
Room 100 WafeiHib@'Avaeatei ly
094 OF FENDING INSPECTIONS '
Hoa }OPTON,SAUIDyO Northampton, MA 01060 T,wgSkta of36rx3u�dl Placa.
phone 413-587-1240 Fax 413587-1272 Pioti t e Mahe-
CNher3pedy e, --. ._ � r
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Premix Address:. This section to be completed by office
81 Redford Drive Map Lot Unit
Zone OverlayDistrkt
Eon St District. Ca Dbaiet
SECTION 2•PROPERTY OWNERSHIPIAUTHORTZED AGENT
32 Osrnercif Records:
Stanley es Kathleen Kochapski 81 Redford�aoRrdgDrive
Name(Prim) Current
otgAAass:
See attached - Taeasom
Signature
2-2 Authorized Agent
American Installations 130 College St., Ste 100 South Hadley, MA 01075
Name(Print) - / Current Ma&g Address:
American Installations \A (. . (- `f- 413-552-0200
SgnWee Tekpepe
SECTION 3• - TED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Butlag $3,830 (a)Budding Ramat Fes
2, Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee /�/
4. Mechanical(HVAC) r/
5.Fire Probcibn �T
e. Total=(1+2+3+4+5) $3,830 Chin*Number 30 Q
This Section For Official Use Only
Budding Permit Number Do
te
mail:
Signature: . g 7r/7
Beetling CommMbmminepedm of Borings Dam
7
Section 4. ZONING AU Intonation Yet Be Completed.Penrdt Can Be Denled We To Incomplete Information
Required by Zoning
TNe coke=so be abed I.by
MOM II1
E= O O
L:= RC LO IC O II
r� L=
®® SUS
Bldg square Footage O O x O O O
ootage
Dari we nd.aSpace bWs pood I , I O O O
BREIMINIn MEM
nu:
A. Has a Special Permltriarlance/FIndisg ever been Issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date hued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book I I Page aiWor Document S
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES 0
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained a Obtained O , Date Issued:
C. Do any signs exist on the property? YES 0 NO O
IF YES, describe sin,type anti Location:
D. Are there airy proposed changes to or additions of signs Intended for the property? YES 0 NO O
IF YES,describe size, type and location:
E. Will the construction windy dlsbab(daerIng,gredtp, lion,or Nang)over 1 ace or 6 It pert of a common plan
Bat will disturb over 1 acre? YES O NO
IF YES,then a Nodharrpton Storm Watar Management Pena from the DPW Is required.
SECTION S-DESCRIPTION OF PROPOSED WORKicheck at apptkabte)
New House 0 Addition 0 Replacement Windows Alteration(s) ❑ Rooting ❑
Or Doors 0
Accessory Bldg. 0 Demolition ❑ New Signs Mg Decks IO Skiing UJj Matt
Bderaeai
Wok:pAtkm�andof
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 Rog -Sheet
_ . i. . ._. . i _.. _
ga.If Now house and oraddltiorttoez(sNDDhouslnq.cumaleht the followirtg;
a. Use of battling:One Family Tem Panty 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 Conservation Compliance. Messdreck Energy Compliance form attached?
h. Type of construction
L Is construction within 100 R of wetlands? _Yes NQ Is construction within 100 yr. floodplain Yes No
j. Depth of basement or celiac goon below finished grade
k. WN bidding conform to the Building and Zoning regulations? Yes No.
1. Septic Tank City Sewer Private well City water SIPply__,_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLES FOR BUILDING PERMIT 11
Stanley&Kathleen Kochapski as Gamer afthe trebled
properly
hereby authorize American Installations
to act on my behalf,In ell matters relative to wok authorized by this building permit application.
See attached 8-I2-I6
Signature ofemat Date
I, American Installations as Owner/Authorized
Agent hereby declare that the statements and Mormation on the foregoing application are true and accurate,retro best of my krwW1edge
and belief.
Signed under the peke and penalties of perjury.
American Installations
Pita Name
American Installations \n/ j . ��1J1/�-�" 812-16
Signature of Owner/Agent Dine
SECTION 8-CONSTRUCTION SERVICES
8.1 licensed Constuction Supervisor: Not Applicable 0
Name at Deena Nander Wesley K. Couture 106178
License Number
130 College St Ste 100 South Hadley,MA 01075 9129117Address Expiration Dale
pV .
•�� 413-552-0200
Signatory Telephone
9.Rea(st rilaHanleknnrovementtantt2etar. - Net APpliceNe 0
Wesley Couture 175982
Company Name Regabe/ton Number
American Installations 6/27117
Address Expiration Date
130 College St., Ste 100 South Hadley,MA 01075 Telephone 413-552-0200
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.re.184,§25C(8f
Wwkem Compensation Insurance affidavit must be completed and submitted with this application.Faure to ptovida this affidavit wl§result
in
the denial of the Instance of the batting pemba.
Signed Affidavit Attached Yes..._.
1l.-Home Owner Exemption
The current exemption for"homeovmets"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 don not possess a license,Drealtd that the ewar ads
a supervisor.CMR T80. Stith Wan Section 11113.M1.
permllon of HomeowneLr.Person(s)who own a parcel of land on which he/she resides or intends to Beside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use end/or farm
structures.A person who construe':More than one bane Ina two-year period shall not be eonaldared a homeowner.
Such"hameownee'shall abrmt m the Building Offiaal,ons form acceptable to the Building Off daI.that kdahe shaft be
reammask for all suck work ronformed ander the beading nrmlS
As acting C,,oastruepon 8noerrfsar your presence on the job site will be required from lime to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chepter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Taws Annotated,von am be liable for person(s)
you hire to perform work for you under this permit
The undersigned stomomvuee certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Load Zoning Laws and State ofMarelonam•General Laws Annotated.
Homeowner Signature
•
City of Northampton
y Massachusetts f `�k
rime §^... ..:0see
DEPARTMENT OF BUILDING INSPECTIONS ;IL
212 Main Stant • Naic pal Building /O
`+1= MottLnnptan, 10 01060 N.
BO
Property Address: 81 Redford Drive
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property Owner
Name:
Stanley&Kathleen Kochapski
Address: 81 Redford Drive
City: state: Florence, MA 01062
I, American Installations (contractor)attest and affirm that the building I intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor Si at
\ / I(Date
8-12-16
BB
POMPOUSill11141101111:111
www.AmericanInstallations.com
• GcensSJ&Inmr7J
MA CSL p'106178
MA RegBbOti0npll5%d2
American Installations
130 CoNge weft suite 100,south Malley,MA 01075•Office:(413)5524200 Fn:(413)5524202•Lmun:wppeneAm.bnlmlwom.uwn
Kochapski,Stanley&Kathleen 7/8/2016
ono ..
81 Redford Drive Florence MA 01062
mm Mae)4135223650 sjkochap®comcast.net
435620 mw lain 16-1154
Quantity Unit Unit Cost 2075 Total
Mr/Duct Sealing
AIR SEALING 16 man hour $ 85.00 $ 1,350.00
Air/Duct Sealing $ 1,350.00
Air/Duct Sealing Incentive $ (1,020.00)
Air/Duct Selaing WX Balance $ 340.00
Weatherization
FLAT-45 OPEN R-14 1,580 sqft $ 1.13 $ 1,898.40
DAMMING R-38 140 linear ft $ 2.05 $ 287.00
HATCH SEAL&INSULATE 1 each $ 60.00 $ 60.00
VENTILATION CHUTES 75 each $ 2.00 $ 150.00
DOOR WEATHERSTRIPPING W/SWEEP 1 each $ 75.00 $ 75.00
Air/Duct Sealing WX Balance 1 lump sum $ 340.00 $ 340.00
Total Weatherization $ 2,810.40
Weatherization Incentive $ 2,OOO.W
Total Project $ 3,830.40
Total Utility Contribution $ 3,020.00
Total Customer Contribution $ 810.40
WARRANTY' mean mace Hata,,LKweprovidetheabove stated meowner with a 2 year wo,looaothip wan.nn.
hereby proposes to furnith material and m ro„o(000pioto the above scope of wcn in accordance wah the above specifications and all local and mate building
✓og• obtions for the mai Contract Value as nee herein
ACCEPTANCE OF PROPOSAL:me above pricey specifications and TOTAL CONTRACT VALUE= $ 810.40
conthtions are satisfactory and are hereby aYou are
authorized to do work as specdied.Payment will bels down prior to Down Payment= $ 270.00 ®c
start o(wo;and balance due upon Completion. PA I0
Balance Due Upon Completion= $ 540.40
\1qj�^� ���,� 7/18/2016
w n-"+-l«ml R�/ssoivl// U� ons 7/18/2016
THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE MID 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 JURISDICIONS.
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 ANNUMI 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 NE CLIENT.IN ADDITION,CLIENT UNDERSTANDS THAT IN FAILING TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY
HAVE THE RIGHT TOA LEIN ON THE PROPERTY.
3.THE COMPANY AGREES NAT 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 A' MELT 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 AND USE OF
SUCH EQUIPMENT AND/OR PRODUCTS IN ORDER TO ACTIVATE SUCH WARRANTIES.
6.
N
THE QUOTATION ON E 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 LIABILITY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AGREEMENT PRICE EXCEPT TONE 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 10 PROTECT AREAS OF WORK.
9.THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFIOENCIES 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.IF A PREEXISTING 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
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 ASA RESULT OF ANY KNOWN OR UNKNOWN MOISTURE CONDITIONS.
11.THE COMPANY IS NOT RESPONSIBLE FOR,AND THE CLIENT AGREES TO HOW 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
1S.INDIVIDUALS.N AGREEMENT.INCLUDING ME PROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE,CANNOT BE CHANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED BY BOTH THE
COMPANY ANO THE CLIENT.
16.ANY REPRESENTATIONS.STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND NOT REUED 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
M 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 ANGES 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%RESTOCKING
FEE BASED ON THE COST OF SAID MATERIALS.
21.THIS AGREEMENT SHALL BE VONLY UPON ITS ALL
HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL.THE COMPANY RESERVES THE RIGHT
TO REVOKE
FROM DATE IT ISEXECUTED 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 ENFORCEBIUTY 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 ARBIWATON 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 iO 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 MAA 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.
9 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(99 Im3)of
Construction Supervisor enclosed space.
'Licens :CS-108178
\cETlq 4a.
WESLEY COIJTI
166 NORTH MAIN I -
South Hadley MekB ) \
Failure to possess a current edition of the Massachusetts
�.-�2 � ,a State Building Code is case for revocation of this license.
J .- -Gye..I,,nExpiration
Commissioner 09/29/2017 FM'DPS Licensing information visit wmv.Massrov/ors
iite W'047 , r
ki
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 TO 265208
AMERICAN INSTALLATIONS, LLC. -
WESLEY COUTURE
130 COLLEGE STREET SUITE 100
SOUTH HADLEY, MA 01075 -
, T9^"et Address and reWrn tart Matk reason for cange.
SCA I 0 206105/11 Address Renewal C Employment 0 Lost Card
cc-2,.'F .urea/7A fo//la /.z.a«
Offe ofConsumer Aff in&BusinessRegulation License or registration valid for individul use only
al OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistratiun: 175982 Type: Office of Consumer Affairs and Business Regulation
Expiration ':6272017 LLC IO Park Placa-Suite 5170
Boson,MA 02116
AMERICAN INSTALLATIONS,LLD.
WESLEY COUTURE
130 COLLEGE STREET SUITE 100 U c er sr- /n l�signature
SOUTH H40LEV,MA 01075 Undersecretary N valid without signature
A`OR� CERTIFICATE OF LIABILITY INSURANCE 9igNzD"�5
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. 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(es)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 endorsemeMts).
PRODUCER ca STTAXT Linda Powers
Webber S Grinnell int MV (413)586-0111 PAs (41315116-646i(41315116-646ip,T„ mo
S North King Street PUD ES.1poMerogrebberandgrinnell.Com No,
IHSURERs)AFFORDING COVERAGE NAICY
Northampton HA 01060
amN INSURER ss1910Yere MLLLaS Casualty
INSURED M15useseAmGTAIM/1111 =ARP
American Installations, ZLC INSURER C:
Attn: Was 6 Suzanne Couture INSURER D:
130 College Street Suite 100
INSURER E: ...
south Aadlay MA 01075 MSURERF:
COVERAGES CERTIFICATENUMBERMaster 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. NOTVATHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Valli 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.
YISRPou FR Emmy EX I....
LER TYPE OF INSURANCE !H 0Iy1g0ILYVh PIGMY NUMBER IMWTST iMMININYINII DIMS
R COMMERCIAL GENERAL LMBtIFY 1.000,000
EACH AIIFENCE
A X OWMSMAW _ OCCUR PREM SE5 EOmCvb,m 50,000
503535216 9/4/2015 9/4/2016 MED EXP(Any one Famml 10,000
PERSONAL a ADV INJURY 1,000,000
GEN1AGGREGATE LIMIT APEUPS PER. GENERAL AGGREGATE 2,000,000
X FYAICT 2EPRei F I Lac PRODUCTS-COMP/DRAW 2,000,000
OTHER:
AUTOM0514615:231ury COMBINED SINGLE LIMIT 1,000,000
(Eaamaa_m
A ANY AUTO BODILY INJURY(Per person)
LO ED g SCHEDULEDAUTOS , AUTOS 583535216 9/4/2015 914/2016 00051/NARY 919r pk440
X HRH/AUTOS X Max OKTEa " PETTY MUMSY •.
limos (Per accident)
PIP-Basic 8,000
X UMBRELLAUAB OCCUR I EACH OCCURRENCE 5 1,000,000
A E}C66$LWB CLAIMS-MADE { AGGREGATE S 1 000,000/
E@p 1 X RETENTIONS 10,000 j (SC3535216 9/4/2015 9/412016 rWORKERS
EAND MP4OYEC ERT M®NTY YIN STATUTETION SI
ANY PROPRIETOR/PARTNER/EXECUTIVE 1 1 EL EACH ACCIDENT 5 500,000
CFFICER/MPNBER EXCLUDED/ NIA
B
Irm1maa.mory1mMi OVIC609917 9/4/001E 9/4/2016 EL DISEASE-EA EMPLOYEES 500,000
L.M00.,gNOF OPERATIONS WO. FI n'FA vII
MIMS under
1 CF firm Snf�npg
A Commercial Property 513535216 9/4/2015 9/4/2016 S S' S10O 20,000
bsuea 51,009 40,000
DESCRIPTION OF OPERAOONS/LOCATIONS I VEHICLES(ACOR3405.AdININNI Raman&SCIFL/o.may G attach&V ma space is feyIR41
Proof of Coverage. Workers' Compensation policy includes class code 5974
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFl1 PD BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNOAZED REPNE5ENTA1TW
Kevin Joyce/LMP 'i A
6E1988-2014 ACORD CORPORATION. All rights reserved,
ACORD 25(2019101) The ACORD name and logo are registered marks of AGGRO
INSIOSenHunr
The Commonwealth of Massachusetts
a _ Department of Industrial Accidents
ecail1=ft Office of Investigations
•E el= • l Congress Street,Suite 100
Boston,MA 02114-2017
"• �� www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Baainess/organizationnndividuaq: American Installations, LLC
Address: 130 College Street,Suite 100
City/State/Zip: South Hadley, MA 01075 Phone#: 413-552-0200
Are you an employer? Check the appropriate box: Type of project(required):
1.® I am a employer with 27 4. D I am a general contractor and I 6. New construction
employees(full and/or part-time).' have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp.insurance.t 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] t c. 152,§1(4),and we have no Insulation
employees. [No workers' 13.❑� other
comp.insurance required.]
"Any applicant that checks box#1 must also fill out the section below showing thea workers'compensation policy information.
r Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit anew affidavit indicating such.
:Contactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
lam 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 Expiration Date: 09/04/2016
SS III
Attach a copy of the workers'compensation policy declaration page(showing the policy nu- mber and expiation date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
• - -I—1
Si, .ture: ,._ v .- l ' Date:
Phone#: Hi3-6.5a-rfgo0
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#: