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36-043 (5) 27 WINCHESTER TER BP-2017-0972 GIS n: COMMONWEALTH OF MASSACHUSETTS Mao Elock:36-043 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MMGLLc.1144/2�A) Category: INSULATION BUILDING PERMIT Permit# BP-2017-0972 Project# JS-2017-001675 Est.Cost:$3067.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. ft.): 10018.80 Owner: LACROIX STEVEN E&JESSICA S Z_ nine. Applicant: AMERICAN INSTALLATIONS LLC AT: 27 WINCHESTER TER Applicant Address: Phone: Insurance: 130 COLLEGE ST (413)552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:2/2712017 0:00:00 TO PERFORM THE FOLLOWING WORK ATTIC & 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# 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 CFFY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 2/27/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner File g BP-2017-0972 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200 PROPERTY LOCATION 27 WINCHESTER TER MAP 36 PARCEL 043 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT AP ION CHECKLIST CLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: ATTIC&BASEME LATION&AIR SEALING THROUGHOUT 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 1 FqI Oy.MATION 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 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 01:1001/ 2 -27. 77 Sign. ;o .uilding 0 icizl 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. 16-1088 ._ _ Department use only Ijr,,, �" L City of Northampton stallas of Permff: Building Department Cixb CuWrivewey Pens 177666 212 Main Street Savior/SepfcAvafia'blhty Room 1004-4 WateNWell Availabilty, n Northampton,MA 01060 Two Sets of SUuclpml Plans U phone413-557-1240 Fax413-687-1272 Plot$wPlat . , Other Spedfy - APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: This section to be completed by office 27 Winchester Terrace Map - Lot Unit. Florence,MA 01062 Pare Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 77_.1 Owner of Record: Jessica LaCroix 27 Winchester Terrace Florence, MA 01062 Name(Mint) Curved hinging Pddress: (413)768-8227 See attached Telephone Signature 2.2 Authorized Agent American Installations 130 College St.,Ste 100 South Hadley,MA 01075 Name(Pang - Gwent Magng Address: American Installations 413-552-0200 Signature Telephone SECTION -ESTHAA ._t r• - e. Cea 1- item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $3,067.53 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost at Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection �/ "'l„� 6. Totala(1+2+3+4+5) $3.067.53 Check Number 3;'�..5 t(p This Section For Official Use Only Permit Number. Iss tssu+red: Signature: Bum Commissionerlinspector of f Section 4. ZONING AB Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information • Existing Proposed Required by Zoning This column to be fined in by Building Dcpadment Lot Size I Frontage I I 1 Setbacks Front Side L: I RJ I L:) l It: Rear =1 i Building Height ` 1 ` In Bldg.Square Footage I 1 I % I ' Open Space Footage % (Let arca mines bldg&paved 1 I 1 1 ' Poking) #of Parking Spaces 1---1 I I Fill: -- ----i a (volume&Lodoe) P A. Has a Special PermitNariance/Finding ever been issued for/on the site? NO O DONT KNOW 0 YES Q IF YES, date issued:i I IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES 0 IF YES: enter Book I I Page and/or Document AL 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(clearing,grading, vatlon,or filling)over 1 acre or Is k part of a common plan that willdlsturb over acre? YES0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. S€CTION 5-DESCRWIION OF PROPOSED WORK(check all applicable) New House 0 Addition 0 Replacement Windows Alterations) [] Roofing 0 Or Doors 0 AccessoyBldg. n Demolition ❑ New Signs Ell Decks (lam Siding fl OtheriPF Brief Descriptionqf —,.. Work Attic anat.= 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 ga.If New house and or addition to existing housing,complete the following: a. Oso 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 constmdion. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each 9, Energy Conservation Compliance. Massoheck Energy Compliance form attached? h. Type ofconshuction t. 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. WK butting codons to the au%kfing 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 BI in RING PERMIT I Jessica LaCroix as Owner of the subject property hereby authorize American Installations to act on my behalf,in all matters relative to work authorized by this building permit application. See attached 2121117 Signature of Owner Date t. American Installations as OwnerfA/mlaised Agent hereby declare That the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. American Installations Print Name American Installations 2121117 Signature of Ovmer/Agent Date SECTION 8-CONSTRUCTION SERVICES $.t Licensed Construction Supervisor: Not Applicable ❑ Name ofugmae Romer: Wesley K. Couture 106178 License Number I30 College St, Ste 100 South Hadley,MA 01075 9129117 Address ,r� Expiration Date l i Ii0 13-552-0200 a re / Telephone 9.Registered Home improvement ConOpotorr _ ' Not Applicable ❑ Wesley Couture 175982 Company Name Registration Number American Installations 6127117 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 c.152,5 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will remit in the denial of the issuance of the btMkt9 permit Signed Affidavit Attached Yes Al No ❑ 1. .-Home Owner Exemption The current exemption for homeowner?was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such halal.to engage an individual for hire who does not pos a license,provided that the owner acts as supervisor.CMR788, SIxidh Edition Section 1083.5,1. Definition of Hemeowner: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 me and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such shall submit to the Buiilding Official,on a form acceptable to the Building Official,tbatbetshe shall be responsible for all such work performed tinder the Malin.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)of theMassaachusetts General Laws Annotated,von may be liable far person(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 ((T Massachusetts roti 4t .. s : 3 DEPARTMENT OF BDIEPING INSPECT TONS i :'C 212 Naim Street • Municipal sullding vN. _AP _ Northampton, MA 01060 Property Address: 27 Winchester Terrace Contractor Name: American Installations Address: 130 College Street Ste. 100 City.State: South Hadley,MA Phone: 43-552-0200 Property Owner Name: Jessica LaCroix Address: 27 Winchester 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 J lI �/.vir . Date 2121/17 11` wow Atermalk•billaborta Sala LIcerdedtllnsureE MACH r loci did Ma Nronror.c•1/S4Ar/ American Installations 130(c4R Stier 5u4 IDASauS 1 0y.MA 01075•x144:14111 mammfa(4113 U •tow&gpimed erortealbtbu,[wn LaCroix,lesaii.a 6115/2016 27 Winchester Tr?. florerte MA 01062 odd 413.768.8222 staaoii0406@grnatcom �. 41/lb •• .'•n 16 21118 Quantity Unit Unit cost Total 31k 50a6tY AIP S(1LINC. • t) man Mur $ BS.W $ 1,020.00 Total Nr Sealing Inceabw` $ 1030.00 Wotvmdon .... fL\i-YW OPEN N-lH _ __. 1,352 h $ 1 Il $ 1hliY> CRAWISPAr. WAIT N10NICx3 INSt 53 soft S 1.10 $ 196.10 H. N 11 13 vttt $ 1.52 $ 1&24 HATCH SEAL&INSULATE - .. 1 each 5 WOO $ 60(X3 DAMMING P-38 -... _ _.. - 35 Wear ft $ 2US S 1115 UVENNMIG H'Oh NSh N]P 14 sit $ 291 5 5503 XtMUVS lrasulAllnx 14 vpt $ 0.25 $ Ia.W Total Incefdyiaed Weat erliathon $ J.03/.O1 Total Non-meeetr.4red WPathenrafian $ 10.50 Total Project S 3.067.53 Total Utility Contribution $ 2,547.77 Iota Customer ConbtbuUon $ SI9.16 W..rwwi. .-.........uw..•..•^1'44`""`"' —w...wmr ae.n're xww�we..•I.4•+"".4v..i...ra. r n•'•N..v... rw SIAwa.�N.ca•4..wa•nrrr..w.......w.0 wt:..v.-nN.w'40' 'buns aiMee.a l ka/N xxf(•wl.t r.rr.T.s Ponce..,oe- e0SAL meaeme once.. nrn.....-n TOTALCONTRACT VALUE= $ 519.76 1m4h n..ai...n.3.nnry..l.nt P e,ew•4.4x•4. .0,ar. / aenonae to do won s dented ew".m wn wci3 sw.....w Down Paymrnt- $ 1]300 �'r Ain/id .e..,t A.vh old Pint dot*Y Comae/Jon Halanre our Upon t:ompfmn= 5 346.16 H I IaCru•..lessrta 6J1513016 l+ng A.Oragwdr -__ 6/15!2016 The Conmwnweatth of Massachusetts p Department of Industrial Accidents Office of Investigations MI"{g ae _� 600 Washington Street m'GI— Boston,MA 02111 s www.mass.govidia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (BUsincs-vorganiuworvindividuap: American Installations,LLC Address: 130 College Street,Suite 100 City/State/Zip_ South Hadley,MA 01075 Phone ii: 413-552-0200 Are you an employer?Check the appropriate box: Type of project(required) { I. tam a employer with 31 4. CII am a general contractor and I C fi_ New construction employees(full and/or pan-lime"' have hired the sub-comradm5 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. Remodeling ship and have no employees These sub-contractors have E_ S. Demolition working for me in any capacity. workers`romp.insurance. (` Budding addition (No workers'comp.insurance 5. [] We are a corporation and its required_) officers have exercised their 10_U Electrical repairs or additions 3.U I nm a homeowner doing all work right of exemption per MGI. I I Plumbing repairs or additions { myself. [No workers'cornp. c. 152.§1(4),and we have no t2❑Roof repairs insurance required"E employees. [No workers 1 tromp.insurance required.] (I t3.'N Other Insulation "Any applicant that docks'box ill must also 41I nm the section below showing their workers'compensation poliev information. 11o/woo/with who suhmis this affidavit ind mating they we doing all work and rive hire omsidc contrm,mrs roust submit a new at➢davit indmaing such. Tomrneorn that check this box roust attached go additional sheet showing the nanm of Ow so toninatore and their workers'comp.polies information. 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 Ponce#or Self-ins ( ie tri AMWJ31485 Expiration Dale' 09/04/2017 Job Site Address"S 3 yVlncheste Ir I�Qctits/StateiZip:__f.__lwCLt!...L_+11/YI ()lad_ 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 tine up to$1,500.00 andior one-year imprisonment,as well as civil penalties in the form ofa stop WORK ORDER and a fine of up to$250.00 a day against the violator. He advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury thin the information provided above is true and correct Iianatnreisi ti/ .0 r Date: dIraI4I Phoned: 413-55 -0200 IOfficial use only. Do not write in this area,to he completed by Ng oriowa official City or Town: Permit/License h Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACRD CERTIFICATE OF LIABILITY INSURANCE DATE i/2Dm1Ts THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIRCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS). AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcylies)must he endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate dorm not confer rights to the certificate holder in lieu of such endorsement(s). _ PRODUCES r°7 Linda Powers NAN Webber & Grinnell PHONE FRE (613)586 0111 RAS No) Ism 58664E1 8 North [ting Street gwpeA sG:1POMHra@Mehberandgr ll.can INSU ERIS)AFFORDING COVERAGE Na1C 11_ Northampton HA 01060 INSURER AE pioyera Mutual Casualty LuI�E4 INSURERS Berkehize Bathaway GUARD Zna. Co. ... _ American Installations, LLC INSURER C: Attn: wee & Suzanne Couture INSURER D: 130 College Street, Suite 100 INSURER E South Hadley 3dA 01075 INSaLER F: COVERAGES CERTIICATENUMB£Rt$as ter Exp 9-2017 REVISIONNUMBER: 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 LEHICH 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 REDUCE()BY PAID CLAIMS. I`SRR. __ ... IRS1t1 _.. oust EFF ......... LIMOS TYRE OF INSURANCE ESSE VIVO POLICYFA)MSER COMMERCIAL GENERAL UAWUTY I SACK OCCURRENCE 1,009,000 TfMAGE Tb-Ereets." 00 A X I CLAIMS-MADE OCCUR P- MISE a. -, sow 500.000 % Liquor. Liabilvty . 503535217 9/4/2016 9/4/2019 MHO EXP Any one serves) _l 10,000 _ PERSONAL&AM:INJURY 1.,000,000 AGGREGATE 2,000,000 POLCYF_ia Pre-LIMIT RPPt IFS LPER. @(GENERAL TS.cOMRR)pAcG 2,000,000 OTHER: • ._, OMOBLE LIABILITY IN L O IT -� 1,000,000 ccool A ANY AUTO i BODILY INJURY ROE Pesos/ ALLOWNED ^% SOHI,DDULEO 5Z35ATIR2 .152179/4/2014 9/41E017 7000EV MART(Pe'acude]oAUTOS _ X HREI)AUTOS X AUTOS ee ' t AGE AVTUB ) ,LPa NM1Y ... . . }. CPBasic 8,000 • X UMRRELLA LIAB ^..OCCUR I I EACH OCCURRENCE S 1,00,00n✓000 A EXCESS LIAB CLAIMS-MAGE •AGGREGATE I'S 1,000,000 OED ( X'REMEMONS 10,000 E,]3S3S21'1 9/4/2016 9/4/2017 - S WORKERS COMPENSATION ' IVx I HER d ,.'I EnH AND EMPLOYERS'[JABTT "'- - -'-- ANY PRCMRIETORIARTNER/EXECUTNE Yi OFFICER/NEWER EXCLUDED? I N rA EL.EACH ACCIOEM S 500,0_00 B IManexaYln Nm ORNC604917 9/4/2036 9/4/2D1E L DISEASE-EA EMPLOYEE S 500000 E yes describe under f - -' ESCRIOTtON OF OPERATIONS SHIER E L.DISEASE•POLICY LIMIT I S 500 009 A Commercial Property EA35352.t1 9/a/2Ol6 9/4/2017 4tcESe SI USG $20,000 Iaeww,obie SI 000 $40 moo DESCRIPTION OF OPERATIONS/LOCATIONS r VEHICLES IAWRD let AEdNIPMI Remarks Schedule,may be atta[Ma Emcee space M nqugE) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTRORIMS REPRESENTATIVE Kevin Joyce/LM.P 'ne 611$88-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025u999c Massachusetts-Department of Public Safety Unrestricted-Buildingc of any use group which Board of Building Regulations and Standards contain less than 35,000 cubic feet(991m3)of Construction Supenisnr enclosed space. License: CS-106178 str' WESLEY COUTUJtE` u ,v p. 166 NORTH MA1tY sal/ t South Hadley MAV Ole : Failure to possess a current edition of the Massachusetts l sa State Building Code is cause for revocation oft is license. J.. �sdf¢r aExpiration Commissioner 09/29/2017 For DPS licensing nfmmattonvht www.massnoviouS the Wo477476942ufecd z cl i c c%uie rkt iticiirP Office of Consumer Affairs and Busi- ss Reg'-lation t 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. SCAI :, 201.1 05111 E Address E Renewal ❑ Employment D Lost Card e's„timneea!/!e/tJf'nbacArne/G . 001ce of Consumer Artairs •&Business •Regulation License or registration valid for individul use only O {fs3c10ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: e" gistmaom 175982 vy VI Type: Office of Consumer Affairs and Business Regulation tO Park Plaza Suite 5170 n>Expiatlon: 6/27/2017 LLC Boston,MA 02116 AMERICAN INSTALLATIONS,LLC WESLEY COUTURE J 130 COLLEGE STREET SUITE 100 /4/ SOUTH HADLEY,MA 01075 Undersecretary - - N valid without signature