24A-209 (3) 24 ADARE PL BP-2017-1475
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-209 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-1475
Project# JS-2017-002457
Est.Cost:$3026.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot size(so. ft.): 5619.24 Owner: BODDY JAMES&EMILY
Zoning: URBp00)/ Applicant: AMERICAN INSTALLATIONS LLC
AT: 24 ADARE PL
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:6/1920170:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC AND BASEMENT INSULATION AND 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 Occu a anc Si!nature:
FeeType: Date Paid: Amount:
Building 6/19/2017 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File it BP-2017-1475
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 24 ADARE PI.,
MAP 24A PARCEL 209 QQI ZONE URB(100)1
THIS SECTION Fat OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid f
}uildinc Permit Filled out
Fee Paid
Typeof Construction: ATTIC AND BASEMENT INSULATION AND AIR SEAI.ING THROUGHOUT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or license 10615
3 sets of Plans I Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFpRMATION 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: She 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
Demolition Delay
Signature g Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain alt 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.
17-1384
DeparM1neid use bii
City of Northampton status of Permit:
,
/
. Building Department Curb Cuwrtyeaay Pemlt
/ \yy1� 212 Main Street sewer/septic Avaflab7ty
J Room 100 WeterlWeil'Availebigty
Northampton, MA 01060 Two sets of$6udtural Plane
��:- . phone 413587-1240 Fax 413-587-1272 Plodsue Pleas
ours speary
PLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
11 property Address: This section to be completed byoffice
24 Adare Place Map A Lot atP 1 Unit
Northampton,MA 0I060 Zone Overlay District
Elm St District - CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
11 Owner of Record:
Emily d lames$odd)/ 24 Adare Place Northampton, MA 01060
Name(Pint) Current Mailing Address:
1802,1829-8956
See attached Telephone
sgrmture
2.2 Authorized Aslant
American Installations 130 College St., Ste 100 South Hadley, MA 01075
Name(Pr+sl} Current Maimg Address:
American Installations 413-552-0200
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be mai Use Only
completed by permit applicant
1. Betiding $3,026.15 (a)Bolding Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5,Fire Proieclbn CC��
6. Total=(1+2+3+4+5) $3,026.15 Check Number 4q eJiA a3 _
This Section For Official Use Only -
Building Permit Number
Date
Issued:
Signature:
Sultans CommSsionedbspeotor of Bulldogs Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size L i
Frontage I
Setbacks Front
Side L: I R:1 L:I It: I
Rear ; I i
Building Height
Bldg.Square Footage — %
Open Space Footage
(rot area minus bMg&paved i I
Parking)
#of Parking Spaces F-1 I
Fill:
(volume&[.action) I
A. Has a Special PermitNariance/Finding ever been issued for/on the site?
NO Q DONT KNOW Q YES Q
IF YES,date issued:I
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
IF YES: enter Book ( Page and/or Document#L
L
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size,type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q
IF YES,describe size,type and Location:
E. Will the construction activity disturb(clearing,grading,excavation,or filing)over 1 acre or is it part of a common plan
that wig disturb over 1 acre? YES Q NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION QF PROPOSED WORK(check all applicable)
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing 0
Or Doors n
Accessory Bldg. ❑ Demolition Q New Signs (n] Decks (p Siding D1 Other Itt
BriDesc oof ed
Wortef Atteiptiannd asement insulation and air sealing throughout
Alteration of Slating bedroom' Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement __Yes No
Plans Attached Roll -Sheet
6a.if New house and or addition to existing housing,complete the following:
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construUiwi. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mesacheck Energy Compliance form attached?
h. Type of construction
Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes TNo
]. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water SupplyT
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Emily 6-James Boddy ,as Ovmer of the subject
property
hereby authorize American Installations
to act on my behalf,in ati matters relate to work authorted by this building permit application.
See attached 618117
Signature of Owner Date
I, American Installations as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knovAedge
and belief.
Signed under the pains and penalties of perjury.
American Installations
Not Name
American Installations 6/8/17
SIgnatze of OwnedAgent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. Not Applicable 0
game of License Holder: Wesley K. Couture 106178
License Number
130 College St.,Ste 100 South adley,MA 01075 9129117
Add<asa .I//� U4,{ £xpba6on Pete
gnathrJ�LI- "413-552-0200
Signature Telephone
B,Redislemd Home improvement contmctor: ' _ '.. _ Not Applicable 0
Wesley Couture 175982
Company Name Registration Number
American Installations 6127/17
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 permit
Signed Affidavit Attached Yes ffi No 0
11. -Home Owner Exemption
The cmmnt 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 788, Sixth Edition Section 1883.5.1,
Definition of Homeowner:Person(s)who own a parcel of land on which betshe resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached simonises sveresoryto such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner shall submit to the Building Official,on a form acceptable to the Building Official that heishe shall he
responsible for all neck work performed under the buildinE 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 the Massachusetts General Laws Aanotated,von 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 Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
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: 24 Adare Place Northampton,MA 01060
The debris will be transported by: American lnamuatinna
The debris will be received by: Waste Management of New England- Chicopee Landfill
Building permit number:
Name of Permit Applicant AmericananInstallationsInon behalf of Emily Cr-James Roddy
6/8/17 �.( W Ut�.tL
Date VVVV Signature of Permit Applicant
City of Northampton
fittif Massachusetts ��' ' rG
�', DEPARThENT OF BUILDING INSPECTIONS �� .a
y- 212 Nein Street • Nuniaipal Buiid1n0 'rte pC'
Notthpten, le. 01060 Wit
Property Address: 24 Adare Place Northampton, MA 01060
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property Owner
Name: Emily&fames Boddy
Address: 74 Mari,Place
City, State: Northampton MA 01060
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 signat 1--:'
i (01/2(/`—'1 diU l�
n
Date U
618117
A www.Amenanlnnziimnn..nnm
Art
9L78'li 'G'te�arra
1.1.11.11111
Licensed&Insured
MA at X'106178
American Installations MA Registration#175982
130 Collage Street suite 120,erne Hadley,MA 01075•Office:1413)552-0100 fax:(413)552-0202•Email:auppor[@NnemmnlManaaonr.com
Boddy,Emily&lames 6/6/2017
24 Adare Place Northampton MA 01060
w..0 802.829.8956 emily@emllyboddy.com l,aa Inn
n.a
451164 aai� 17-1384
lana
Quantity Unit Unit Cost Total
Air/Duct Sealing
AIR SEALING 9 man hour $ 85.00 $ 765.00
WEATHERSTRIP DOOR&ADD SWEEP 2 each $ 80.00 $ 160.00
Air/Duct Sealing $ 925.00
Air/Duct Sealing Incentive $ (925.00)
Air/Duct Selaing WX Balance $ -
Weatherization
CI3AWLSPACE WALL RIO RIGID BOARD _ 103 each $ 4.05 $ 417.15
KNEEWALL HATCH-INSULATE&WS 4 each $ 6000 $ 240.00
KNEEWALL-R-13 FG+2"RIGID BOARD 208 sqf $ 5.25 $ 1,092.00
VENT BATH FAN THRU GABLE 1 each $ 118.75 $ 118.75
•
REMOVE INSULATION 103 sgft $ 075 $ 77.25
REMOVE INSULATION 208 salt $ 075 $ 156.00
Total Weatherization $ 2,101.15
Weatherization Incentive $ 1,400.93
Summer Incentive $ 100.00
Total Project $ 3,026.15
Total Utility Contribution $ 2,425.93
Total Customer Contribution $ 600.23
WARRANTY:American Installannd vd11 providethe aboven omeowner wa year workmanship warranty.
hereby proposes term and labor to complete the above scope of wan in aa"rm"a with the above soeonono"s and an local and state nwao¢
reguistIons kw the Total forbad Value as stated herein.
ACCEPTANCE Or PROPOSAL.The above prices,specifications and TOTAL CONTRACT VALUE= $ 600.23
conditionssatisfactoryand are hereby accepted.Vou
authorized areo&woven pedfied., will be u3 down prior to Down Payment= $ 2D.Oo Ft 6-6-2017
start of work.and balance due upon Completion
Balance Due Upon Completion= $ 400.23 Pi0
rms. — �`- U.,.
Roddy,Emily&lames 6/6/201/
Craig A.Dragovlch // µ�J 6/6/2017
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 CUSTOMERLS)NAMED ON TYE 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 LOCALIDRISDICTIONS.
THE FOLLOWING TERMS AND CONDITIONS ALSO APPLY
1.THIS AGREEMENT IS SUMER TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION.
2.SHOULD DEFAULT BE MADE'N THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(1-1R)PERCENT PER MONTH.
X30%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 RIGHTTOA 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 IS RESPONSIBLE TO CLIENT FOR
COMPLETION OF ALL WORK DESCRIBED IN ATIMELY AND WORKMANLIKE MANNER.
5.ANTIES 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 SUCH
ADDITIONAL EXPENSES PREMIUMS OR COST SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT,
J.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
SOLEY 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 15 NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS.E.G.WOOD ROE,
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 PROBLEMNI 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.
10.THE COMPANY IS NOT RESPONSIBLE,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS ANO/OR DAMAGES,INLCUOING BUT NOT LIMITED TO MOLD
GRONTI,ARISING FROM THE PERFORMANCE OF AIR SEAUNG WORK BY THE COMPANY AS A RESJLT OF ANY KNOWN OR UNKNOWN MOISTURE CONDITIONS.
11.THE COMPANY IS NOT RESPONSIBLE FOR,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES RELATING TO ICE DAMMING THAT MAY
ARMOURING 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 UW Ftt
OTHERWISE NOTED HEREIN,
13.THE COMPANY WILL NOT SE 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,I,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 14A 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 AGREEMENT,INCLUDING THE PROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE,CANNOT BE CHANGED OR ALTERED EXCEPT BYA WRITTEN STATEMENT SIGNED BY BOTH THE
COMPANY AND THE CLIENT.
16.ANY REPRESENTATIONS,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.
15.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 0R DAMAGES FOR THE GREATER OF THE COMPANY'S ACTUAL DAMAGES OP 25%OF THE AGREEMENT FOR RESTOCKING FEE.
10,ANY CHANGES 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%RE-STOCKING
FEE BASED ONTHE 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 P IS EXECUTED BY THE COMPANY IF IT LS NOT EARLIER EXECUTED BY THE CLIENT AND THE REQUIRED DOWN PAYMENT RECEIVED PRIOR TO
THE EXPIRATION OF SUCH W 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.
12,IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABIE THE VALIDITY AND ENFORCEBILITY 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 ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION ASSOCIATION TO RESOLVE THEIR DISPUTE.
26.ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM(LE,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 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 MASS 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.
The Commonwealth of Massachusetts
r Department of Industrial Accidents
y,—; Office of investigations
n_ `� 600 Washington Street
_ * Boston,MA 02111
wanu.mess.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibdv
Name(Bminess/Organiratio&Individuaiy American Installations, I.,LC _
Address:_ 130 College Street,Suite IOU
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.al I am a employer with 31 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 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. workers'comp.insurance. 9. 9 Building addition
(No workers comp.insurance 5. 9 We area corporation and its
required] officers have exercised their 10.0£keirivat repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. (No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs
insurance required]t employees.(No workers'
comp.insurance required.] 13.1A Other Insulation
"Any applicant this cheeks box g must also fill oot the suction below showing their workem'compensation policy information,
r Momeawnem sono submit this affidavit indicating Ihcy are doing all work and them him outside contractors mml submit a new affidavit indicating fuck.
:Contractors that cheek this box most attaelled an additional sheet slowing be name of the antscontractors and their worths'comppolicy information.
I am an employer that is providing workers'compensation insurance for nay emptayees. Below is the policy andjob site
inforwatiorL
Insurance Company Name: Guard Insurance Companies
Policy#or Self-ins.Lie.#;L.�AMWCr7}3r�1�485 { Expiration Date(09/04/2017� �.1 tr
Job Site Address: ra ` A dart ?icct' city/staWZip: i`7oek t �n, LA
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). O 1 0(0°
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 51,500.00 and/or one-year imprisonment,as well as civil penalties in the loon of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations or the DIA for insurance coverage verification.
I do hereby c sander the pains�1andjjpenalties of perjury that the information provided above is true and correct
Signature: n. /fr,� {�n pp
Date: lg I c } _.._
Phone#: 413-552-0200
Official use only. Do not wale in this area,to be completed by city or town of tial
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of-Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector
- b.Otber
Contact Person: Phone#:
A�B CERTIFICATE OF LIABILITY INSURANCE DPT„ D°";sT
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 POLJCIES
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(les)must be endorsed. H SUBROGATION IS WAIVED,sut4ect 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 endorsements).
PRODUCER NA„tADT Linde Potrero
Webber & Grinnell - 'NE I, (413)586-0111 PAA r g1313B6-6481
8 North Ring Street A�SS_lpmnrsPxebberandgriwlall.tom
INSURERS,AFFORDING COVERAGE Nam 6
Northaspton to 01060 INSJRERA lWployers Mutual Casualty
INSURED wwRERBbrkahire Hathaway GOMM Ina. Co.
American Installations, LLC Mums O:
Attn: Wes i Susanne Couture ISR O:
130 College Street, Suite 100 INSURER E:
South Badley WA 01075 IIMaRRF:
COVERAGES CERTIFICATENUMBER36sster Sap 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 MY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY SE 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 RpEpDUU�CE�D pBY PAID CLAIMS. _
I SPOIJCY SIP
IR TYPE a 1MOMNCE MO VIVO POLICY NORM .IIOYPoTYTYI IIBYoaYYYO UNTO
COWEROAL GENERAL L48EJTY EACH OCCURRENCE I 1x000,000
DAMAGE TO RENTED
A R CLAIMS-MADE I I OCCUR PREMISES(Ea auneml 500,000
X llquer.ISability _ 5D3535217 9/4/2016 9/4/2017 MED EXP(Any me person) 10,000
_ 1 I PERSONAL E AIN INJURY 1,000,000
GEM AGGREGATEgLIIMIIT APPLIES PER GENERAL AGGREGATE 2,000,000
IT POUCH !EU I
PRODUCTS-COMP/OP AGG 2,000,000
I OTHER
AUTagSLELIMIT, I
CONI
DANGLE LIMIT(Ea ezolden0 1,000,000
A MANY AUTO I BCOILY INJURY(Per peal)
ALL UTO EO R SCHEDULED 5E3535217 9/4/2016 9/4/101/ BODILY if IURY(Pe,avant)
R HIRED AUTOS X AUOVMED PROPERTYrDAMAGEADASA
-- -
AUTOS (Per
NPemlc 8,000
R UMMELLA IAB _ OCCUR EACH OCCURRENCE 1,000,000
A �I EXCESS LW :CLAIMS-MADE I AGGREGATE 1,000,000
I DED R RETENRONA 10,000 533535217 9/4/2016 19/4/2017
WORKERS COMPENSATION PER 0TH-
AND EMPLOYERS'WORDY YIN r STATVIE FR
ANY PROPRIETOWPART,EWEXECLMVELi
NIA EL.EACH ACCIDENT 500,000
B °FFCERMEMBER EXEXCLUDED?
I(Wn6Mm,a KM '0PXC609913 9/4/2016 19/4/2017 E L DISEASE-EA EMPLOYER 500,000
NYn Yaglp6 eWN
ESCRIPTJOof NgPEM11OF babe
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CE.L DISEASE-POLICY LIMIT 1 500,000,
5A3535217
A Commercial Property9/4/2015 omens 9/4/2017 ens stow $20,000
burn'Lb51000 $40,000
DESCRIPTOR OF OPERATIONS I LOCATORS VEMCLES(Aanm IPL AdMEael REDDEN bWpe,may A MI✓M C men y.ce M,p1M)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WmH THE POLICY PROVISIONS.
AUTHOR/2EO REPRESENTATIVE
Kevin Joyce/LMP <'— 3. 1
di 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
IN802517n,1n,l
Massachusetts-Department of Public Safety ig
Unrestricted-Buildings of soy Use group which
contain
Board of Building Regulations and Standards than 35,000 cubic feet(991m5)of
Construction Suiten Bar enclosed space. ..
License:CS-108175 `
Licen
WESLEY
EY courtati --16MAWf li'k
Soatb Hadley MA7O1 ^,,
Failure to possess a current edition of the Massachusetts
11 State Building Code is cause for revocation of this license.
��.—pr'.mesa Expiration - For DPS staving information aft www.Mau.Gov/DP5
Commissioner O9/2912017
C,r4e `fif . . 0 'if /a 0/2
G0/2 / / vf.1,
tilt
cl Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: LW
AMERICAN INSTALLATIONS,LLC. Re piration. 175882
130 COLLEGE STREET SUITE 100 Expira0on: 08/28/2018
SOUTH HADLEY,MA 01075
Update Address and return card. Mark reason for change.
a TTI 0 20M 05/11
E2 Address E2 Plar.eand=Employment. ❑LsstCerd
"2e`F/inni.,..w,eaA/,rilay,.rl..:ao
Ones of Consumer Alain&Business Regulation
yT HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE:LLC before the expiration date. B found return to:
6%' R .. -1S i Exalt=/26/201OMce of Consumer Alain and Business Regulation
AM1,��'Y 176052. 06/2R/2019 10 Park Plaza-Sulte 5170
RICAN INSTALLATIONS.LLC. Boston,MA 02116
WESLEY COUTURE a2-CE-C21--
/1/1/4417-
130
COLLEGESTREETSUITE100
SOUTH HADLEY,MA 01075 alidout
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