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06-023 (8)
56 LEONARD ST BP-2017-1348 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 06-023 CITY OF NORTHAMPTON Lot: -0Ot PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2017-1348 Project# JS-2017-002240 Est. Cost: $3418_00 Fee:S55.O0 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Grouu: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. ft.): 40815.72 Owner: RYAN JAMES M& BRENDA M Zoning: URA(I0O)/ Applicant: AMERICAN INSTALLATIONS LLC AT: 56 LEONARD ST Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:5/23/2017 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 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 5/23/2017 0:00:00 $65.00 212 Main Street Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File N BP-2017-1348 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200 PROPERTY LOCATION 56 LEONARD ST MAP 06 PARCEL 023 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid ) Building Permit Filled out Ij.Lp Fee Paid Typeof Construction: ATTIC AB ENT INSULATION &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 INFORMATION 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 PermitVariance* Received& Recorded at Registry of Deeds Proof Enclosed_ _ Other Permits Required: Curb Cut from DPW Water Mailability 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 Del i.- Ile y Jr �� Signatu e of Building O': sl 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. 17-1218 Deparunent use only City of Northampton Status of Permit. Building Department CurbCutiDn away Pemdt 2 212 Main Street sews Aseptic AvaItabgxy t11h1 Room 100 WatsrMeg Availability, Northampton, MA 01060 TWp Sots of Structural:Plans L- = phone-413-587-1240 Fax 413-567-1272 PIon$/ Plans APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: mThis section to be completed by office 56 Leonard Street Map l 11 iLot lJ Unit Leeds,MA 01053 Zone Overlay District Elm St.District, - CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 3-1 Owner of Record: lames e4 Brenda Ryan 56 Leonard Street Leedc MA 01053 Name(Pint) Current Mailing Address: (413)348-2931 See attached Telephone Signatoce 2.2 Authorized Agent: American Installations 130 College St., Ste 100 South Hadley, MA 01075 WW1(Print) Gwent Malang Address,: American Installations 413-552-0200 Signature Telephone SECTION 2•ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $3418.98 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection _ r G,� 6"- 6. Total R(1 +2+3+4+6) $3,418.98 check Number 431 `-' This Section For Official Use Only Date Budding Permit Number issued: Signature: Building Conankeimwdlnspector of Buildings Date Section 4. ZONING Ag 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 Depament Lot Size i I 7 Frontage ( I I F Setbacks Front Side L: J R:I L:4 J It: I I = Rear I l Building Height _ I Bldg.Square Footage 'I Open Space Footage % (Lot arca minus bldg&paved LJ I I I I I puking) A of Parking Spaces nn I J I Fill: (volume&teem®) I A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW O YES O IF YES,date issued:I 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//IL__ I 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: I 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,or filling)over i acre or Is it part of a common plan that will disturb over i acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House (l Addition ❑ Replacement Windows Alterafron(s) ❑ Roofmg 0 Or Doors 0 Accessory Bldg_ 0 Demolition 0 New Signs [D] Decks (D Siding 01 Other[fi� ......� Brief Description of Proposed Work Attrc and basement insulation and air seating throughout Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes �No Plans Attached Roll -Sheet sa.If New house and or addition to existing housinq,.complete 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 tonstru:Bar. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Blasscheck Energy Compliance form attached? h. Type of construction 1. 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. Wig building conform to the Buikgng and Zoning regulations? _Yes No. Septic TankCity Sewer Private wellCity water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT James &Brenda Ryan as Comer 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 5/18117 Signature of Owner Date 1, American Installations as Owner/Authorized Agent hereby declare that the statements and Infonnation an the foregoing cppdhagon are hue and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. American Installations Print Name American Installations 5/18117 Signature of OwnertASent 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 Addre Explaton Date /� 77, 13-552-0200 ‘itnatu[7 ^/U� Telephone 9.Registered Home Improvement Contractor _ . - _ � Not Applicable ❑ Wesley Couture 175982 Company Name Registration Number American Installations 6/77/17 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,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the building penniL Signed Affidavit Attached Yes K 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 structures.A person who constructs more than one home in a two-year period shall not he 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 building permit. As acting Construction Supervisor 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 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 responsibility for compliance with the State Building Cade,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature City of Northampton n,. 4 =SS S�i / Massachusetts ♦ t 4 DEPARTMENT OF BUILDING INSPECTIONS . 212 Nein Street a Nunieipal Building 00? `_p'C.✓ Northampton, MB 01060 kilt In Property Address: 561 vonard Street. I Beds, MA 01053 Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley, MA Phone: 43-552-0200 Property Owner Name: lames&Brenda Ryan Address: 561 pollard Street City, State: Leeds, MA 01053 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. Con vacgpature ( _J'S.( i Date 5/18/17 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 56 Leonard street,Leeds,MA 01053 The debris will be transported by: American Installations The debris will be received by: Waste Management of New England Chicopee Landfill Building permit number: Name of Permit Applicant American Installations 5/18/17 w1,11 I� itA, Date Signature of Permit Applicant \i w w .Amencanlnstauae < m onso BBB-JEN _ii • Licensed&Insured \ MA St p:106178 American Installations MA Registration#175982 130 College Street Suite MMO,South Hadley,MA 01015•Me:(413)552-0200 Fax:(4131552-0202•(mail:myvon@Amenomnstalmdons.com Ryan,James&Brenda 5/11/2017 56 Leonard St Leeds MA 01053 an wee 413-586-8285 theryan55@verizon.neteve mw 450 402 :reit w"�il 17-1218 33.3, vee Quantity Unit Unit Cost Total Air/Duct Sealing AIR SEALING 12 man hour $ 85.00 $ 1,020.00 Air/Duct Sealing $ 1,020.00 Air/Duct Sealing Incentive $ (1,020.00) Air/Duct Sela ins WX Balance $ - Weatherization CRAWISPACE WALL R10 RIGID BOARD 188 each $ 4.05 761.40 ATTIC FLAT.5"OPEN R-19 CELLULOSE 768.5gft $ 1.26 967.68 ATTIC DAMMING-R-38 FIBERGLASS 26 soft $ 2.05 53.30 PULL DOWN STAIR-THERMADOME 1 each _$ 200.00 200.00 INSULATED BATH EXHAUST HOSE 1 each $ 60.00 6000 XNEEWALL-2"RIGID BOARD 56 soft $ 3.85 215.60 REMOVE INSULATION 188 soft $ 0.75 $ 141.00 Total Weatherization $ 2,398.98 Weatherization Incentive $ L693.49 Summer Incentive $ 100.00 Total Project $ 3,418.98 Total Utility Contribution $ 1,813.49 Total Customer Contribution $ 605.50 WARRANTY:Ame mmn installations,LLC we provide the above stated Fo meowner nitro 2 year workmanship warranty. Arne man LC hereby proposes to furnish all material and labor ea complete the above scope of week in accorda nee Wee the above specifications and all local and state building regulations for the TotalCOntraCt Value as Stated h... ACCEPTANCE OF PROPOSAL:The above prices,specifications and TOTAL CONTRACT VALUE= $ 605.50 conditions are satisfactory and are hereby accepted.You are authorized to do work as specified Payment will 1/3 down prior to Down Payment= $ 200.00 Q F/11/17 start of work,and Ealancedu upon tloap Balance Due Upon Completion= $ 405.50 jG9(YV 5/11/2001] arm Jim Pierma rini V '.,[Amy 5/11/2017 • THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND 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 TIE 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 JURISDICTIONS. 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 ANYCONDITION. 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 11-1/E)PERCENT PER MONTH. (15%PER ANNUM)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 THE CLIENT.IN ADDITION,CLIENT UNDERSTANDS THAT IN FAILING TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY HAVE THE RIGHT TO A LEIN 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 15 RESPONSIBLE TO CLIENT FOR COMPLETION OF ALL WORK DESCRIBED IN A TIMELY AND WORKMANLIKE MANNER. S.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.THE QUOTATION ON THE PAGE HEREOF DOES NOT INCLUDE EXPENSES OR CHARGES FOR BOND OR INSURANCE PREMIUMS OR COSTS BEYOND NORMAL INSURANCE COVERAGE,ANY SUN ADDITIONAL EXPENSES,PREMIUMS OR COST SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT. D 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 SOLES DUE TO THE COMPANY'S NEGLIGENCE. B.DURING THE 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 APPROPRIATE ACTION TO PROTECT AREAS OF WORK. 9.THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES 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 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 TOCORRECT THE PROBLEM(S)ON A TIME AND MATERIAL BASIS.CLIENT AGREES THAT SUCH CONDITIONS ARE UNAVOIDABLE BY THE COMPANY AND SHALL NOT BE CONSIDERED A VIOLATION OF THE 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. 1D.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 A R SEALING WORK BY THE COMPANY AS A RESULT OF ANY KNOWN OR UNKNOWN MOISTURE CONDITIONS. 11.THE COMPANY 5 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 AFTER THE PERFORMANCE OF WORK BY THE COMPANY. 12.REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,ROOF JACKS,VENTILATORS,FLASHING,RAFTERS,IOISS,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 G 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 INDIVIDUALS. 15.THIS MENT,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. IS.ANY REPRESENTAPONS,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. 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 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 CHANGES TO MATERIALS BY THE CLIENT(BRAND,STYLE,COLOR,ETC.)AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO TEE CLIENT COULD RESULT IN A 5%RE-STOCKING FEE BASED ON THE COST OF SAID MATERIALS. 21.THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL THE COMPANY RESERVES THE RIGHT TO REVOKE THIS PROPOSAL 90 DAYS FROM DATE RIS EXECUTED 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 DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE PROPOSAL,COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE.N 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 ENFORCEBI LITY OF THE REMAINING PROVISIONS OF THIS AGREEMENT SHALL NOT BE AFFECTED THEREBY. 23.ARBITRATION:IN THE EVENT THE CLIENT ANO COMPANY HAVEA DISPUTE REGARDING ANY OF THE TERMS,CONDITIONS,PROVISIONS,OR PERFORMANCE OF THIS AGREEMENT,THE PARTIES AGREE TO PLACE THE MATTER INTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION ASSOCIATION TO RESOLVE THEIR DISPUTE. 14,ANY UNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STAR SPONSERED UTILITY PROGRAM H.E.MASS SAVE.)IS SUBJECT TO THE AVAILABILITY OF QUALIFYING STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTILITY PROGRAM IS DISCOUNTNUED.FURTHERMORE,THE TERMS AND CONDITIONS OF STATE SPONSERED UTILITY PROGRAMS MAY BE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE. 15.A25.AMERICAN INSTALLERS,LLC IS NOT AN AGENT OF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE°ENERGY PROGRAM. 36.CLIENT IS REPSONSLBLE FOR THE PAYMENT OF ANY AND ALL FEDERAL,STATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AGREEMENT. gik The Commonwealth of Massachusetts I+s=a, Department of Industrial Accidents _;lIl__: Office of Investigations — 600 Washington Street 9 - Boston,MA 02111 www.mass.gos/dia Workers'Compensation Insurance Affidavit: BuilderslContraetorstEleetrieianstPlumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 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): t.❑x I am a empioyer with 31 4. ❑ t am a general contractor and I 6. 0 New construction employees(run and/or pan-lime).' have hired the sub-contractors 2.❑ I am a sok proprietor or partner- listed on the attached sheet,t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. workers'comp, insurance. 9. 0 Building addition (No workers'comp.insurance 5. 0 We are a corporation and its i required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGT I I.❑ Plumbing repairs or additions myself.[No workers'comp. c. 182,§I(4),and we have no 12.0 Roof repairs insurance required.]t employees.(No workers' comp.insurance required.] 13.2 Other Insulation *Any applicant that checks bon In muss also fill out section below showing their wantons'compensation policy information. f Homeowners who submit this afdavih imhaaling they are doing all,cork and Ihen him outside cunhaciors must submit a new aliW.Ht indicating wdi. tont-tutors duo cheek this box mud attached an additional shoot showing die name of the subcontractors and their wnrkeri comp.policy information. I an,an employer that is providing workers'compensation insurance far my employees Below is the policy and job site information Insurance Company Name: Guard Insurance Companies Policy#or Self-ins. Lie.#: AMWC731485 Expiration Date: 09/04/2017 pp /�} Job Site Address: 5 CI LCtlf10..Ca F S* City/State/Zip: I..e.C.CA.�j i - In 0\053 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$I,500.00 oro/or one-year imprisonment,as well as civil penalties in the form of 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 Ihepains and penalties of perjury that the Information provided above it true and correct mat at.. ,iat ,„Lrf 444/N Dote: 5 1S in— / ! ...... Phone#: / 413-55 0200 _ _ • ] 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): I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Persou:, Phone#: ----.1e A�o CERTIFICATE OF LIABILITY INSURANCE DATE(h""o"s" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TIE CERTIFICATE HOLDER. TNS 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 N an ADDITIONAL INSURED,the polky(es)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 don not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER so CT Linda Powers Webber G Grinnell PHONE , (413)586-0111 I FAX (HT 594-6481 8 North Xing Street ' s%1powers@webberandgrinnell.corn INSUREIM AFFORONB COVERAGE NMC4 Northampton NA 01060u.awsaa IMployers Mutual Casualty INSURED INSURER a Berkshire Hathaway GUARD Ins. Co. American Installations, LLC INSURER C: Attn: Wes & Susanne Couture INSURER 0: --- 130 College Street, Suite 100 INSURERS: South Badley LA 01075 INSURER F: COVERAGES CERTIFICATE NUMBERHaater Hap 9-2017 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 CONTACT 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. /NSA MOLAR, LTR TYPE OF INSURANCE MD,AND, POUCY WISES OrenFn Iw1VOPoIRLY Ern owl o8 COMMERCIAL GENERAL LAWNY WY1'YEACH Der URRENCE I 1,000,000 A X CLAIMSMADE I OCCUR PRFNI FI OREMEO 500,000 PRFNISF r0 RENTS X Limier liability__. 1503535217 9/4/2016 9/4/2017 MEDEXP(My am Imran) 10,000 J 1 PERSONAL&AMINJURY 1,000,000 GENI AGGREGATE UNIT APPLIES PER GENERAL AGGREGATE 2,000,000 X 1 POLICY E jET I LOCA PROpKTS-COMP/PAGO 2,000,000 I OTHER: '.. I AUTOSOSI COMBINED LE LIABILITY ED SINGLE Ur(Ea moideno f 1,000,000 A .` 'ANY AUTO I BODILY INJURY Ne,Ramon) S ALL OWNED 1 SCHEDULED NTOS R AVIS s 5E3535217 9/4/2016 9/4/2011 &DOILY INJURY/PS NONED 1 Per ROP ILDAMAGE GE f H !ARE)AUTOS X Aim R UMeRF33w uAB INP-Bao $ 8,000 — OCCUR EACH OCCURRENCE 1 1,000,000 A :—,'EXCESSLAO CLAIMS-MADE AGGREGATE f 1,000,000 :DED 1 H RETENTIONS 10,000 333535217 9/4/2016 9/4/2011 I S WORMERS COMPENSATION I r PER 0TH- AND EMPLOYERS IJAUfl' YIN STATUTE ER ANY PR.eRIETMNARTNERtXECUTNEEL.EACH ACCIDENT f 500 000 B OFFICER/TEMPER EXCWCEOT NIA _-- weryInNH) 'ORwC609931 9/4/2016 9/4/2017 EL dSEASEEA EMOYEE f 500,000 rc yesscribe under F DESCa PLRIPTIONOOPERATONSOwIw EL DISEASE-POUCY LSAT 1 500.000 A I Commercial Property • 5x.3535211 9/4/2016 9/412011 uedlMpe SRW 920,000 a69dteI1 am 840,00o DESCRIPTOR OF OPERATIONS I LOCATIONS/MUCUS ADOPT 101,Aawo*l MmPAP Schedule.may be Weld If name space Is mp9Ml CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXMRATON DATE THEREOF, NONCE TILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZE:REPRESENTATIVE Kevin Joyce/LMP 1 ©1988-2014 ACORD CORPORATION. All dghis reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSO2S/Town, 9 Massachusetts-Department of Public Safety Unrestricted-Buildings of any use group Which Board of Building Regi$ations and Standards contain less than 35,000 cubic fret(99 Ima)of Construction Supervisor lffille enclosed space. License: CS-106178 WESLEY COUTUJtE 4P 166 NORTH MAIM Fla ' _ South Hadley MAT 01 Failure to possess a current edition of the Massachusetts ♦-- .x,u va -v State- Building Code is use for revocation of this license. Jam„-d Expiration Commissioner 09/29/2017 Em DPS ticwninglnrarmationvisit www.Mass.Gov/DPS c Ae Wit 2 L V A jelly ti 3 Office of Consumer Affairs and Busi ss Reg�-lation , 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cognaetor Registration Registration' 115962 Type: LLC Expiration: 6/27/2017 Trp 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 a 2 assn LI Address 0 Renewal ❑ Employment f] Lost Card e `rof,-),,o.,r„ea/N itndGerael,,du -L.-Office of Consumer Allain&Business Regulation License or registration valid for individul use only R r( 910ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: III egistmtion 175982 LType: Office of Consumer Affairs and Business Regulation Il=;Expiration: 5272017 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 AMERICAN INSTALLATIONS,ELG WESLEY COUTURE / 130 COLLEGE STREET SUITE 100 ///)/�/A/I/X L-/✓r/t SOUTH HADLEY.MA 01075 Undersecretary - N valid without signature