10B-002 (4) 112 AUDUBON RD BP-2017-1513
GIS 9: COMMONWEALTH OF MASSACHUSETTS
Man:Block: 10B-002 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate+o : NSUL TION BUILDING PERMIT
Pernik# BP-2017-1513
Project# JS-2017-002529
Est Cost:$2943.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot$ize(so.ft.): 39988.08 Owner: EVANS ALAN J
Zoning:RR(I00) Applicant: AMERICAN INSTALLATIONS LLC
Al': 112 AUDUBON RD
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:6128/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC & 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 Occupancy signature:
FeeType: Date Paid: Amount:
Building $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1513
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (4E3)552-0200
PROPERTY LOCATION 112 AUDUBON RD
MAP 10B PARCEL 002 001 ZONE RR(100V(
THIS SECTION FOR OFFICIAL,USE ONLY:
PERMIT APPLICATION CHECKLIST
,NCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid ILltLlq`'1'
Building Permit Filled out
Fee Paid
Typeof C struction: ATTIC&BASEMENT IN LATIQN AND 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:
IN/
pproved 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 Pemtits 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
de ✓ / 2 / ! 7
Si:-. a of luild 'g •fcial 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.
17-1527
•.City of Northampton Status of Permit
Building Department cutb CuuOriveaey Peru
c nit 212. Main Street Sewer/SeplicAvallabfity
Room 100 Water/Well Avagabaity::.
Northampton, MA 01060 Two Sets of Structural Plans
\ 5, - phone 413-587-1240 Fax 413-587-1272 PIoUSIte Plans .
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AONE OR IWO FAMILY DWF,a RIG
SECTION 1-SITE INFORMATION
1.1 PIODtlHV Address: Tffh11is;Fectioa to be completed lay office
112 Audubon Road Leeds,MA 01053 Map 10 Lot 0V) Unit
Zone Overlay District
EM St.District CB District
SECTION 2-PROPERTY OWN ERSHIPIAUTHOR2E0 AGENT
2A Owner of Record;
Alan & Anae Evans s . e r t r - s 4 A 0j053
Name(Print) Current Meiling Address:
(4fi) S86-5181
See attached Teiepiione
Signature
24 Authorized Agent:
American Installations 130 College St., Ste 100 South Hadley,MA 01075
Name(Pmt) Current Malting Adams:
American Installations 41.3-552-0200
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COST$,
Item Estimated Cost(Dollars)to be Official Use Only
completed by pemrft applicant
1. Bugg $2,943.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Consttuciion from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection _./(
6. Total=(1 +2+3+4+5) $2,943.00 Cheat Number w_ e.? $4s-
This Section For Official Use Only /�`��
Building Permit Number. DateIssued*
Signature:
Building Commissionemnspector of Buildings D
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 Depumeat
Lot size L
Frontage I
Setbacks Front
Side L: I R:I I L: It I i
Rear r
Building Height
Bldg.Square Footage En I i h L _I i I
Open Space Footage %
(Lmarea minus bwg&paved ( I I
paring)
#of Parking Spaces r
Fill:
1.1
(volume&bacaaon)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
140 O DONT KNOW O YES O
IF YES, date issued:)
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book I Page I and/or Document tt
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 0 , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location: I i
I). 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(cleating,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO (3
IF YES,then a Northampton Storm Water Management PennRfrom the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House D Addition 0 Replacement Windows Alteration(s) 0 Roofing 0
Or Doors 0
Accessory Bldg. ❑ Demolition 0 New Signs [DI Decks (i= Siding Other(pi
Brief Description ofProposed
work: Attic 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 existinq'hogsinq,.cotnpiete the following:
a. Use of butdkng: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 constnnxion. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstovos Number of each 4
g. Energy Conservation Compliance. Masschadr Energy Compliance form attached?
h. Type of construction
I. Is construction within 100 t.of wetlands? Yes , No. Is construction within 100 yr. floodplain YesNo
j. 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 Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Alan 8r AnneFvans es Omer 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 attached6124117
Signature of Owner Date
I, American Installations as Owner/Autwrized
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
Pent Name
American Installations 6/24l17
Slgnaue of Ovae:Agent Date
•
SECTION 8-CONSTRUCTION SERVICES
Al Licensed Construction Supervisor: Not Applicable ❑
Snit License Rotdgt: Wesley IC Couture 106178 _
License Number
130 College St,Ste 100 South Hadle .MA 01075 9/29/17
Address / // Expimson Date
Hofi j ( 14/ 6/ X3�� 2o200
Sig pe U Telephone
0,Registered Horne ImproVement Contmoldr. Not Applicable 0
Wesley Couture 175982
Company Name Registration Number
American Installations 6/26/19
Address Expiration Date
130 College St.. Ste 100 South Hadley, MA 01075 Telephees 413-552-0200
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G,L.e.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted With fits application.Failure to provide this affidavit will result
in the denial of the issuance of the building permit
Signed ARdavit Attached Yes ffi No......
U. Home Owner Exemption
The mama exemption for"homeow"homeowners"was extended to include Owner-oceunied Swellings of one(I) oc 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 180. Sixth Edition Section 108.3.5.11
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.Amerson who constructs more than one home in atwo-year oeried shall not be nonsidergl)a honreowner-
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 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 ofEmpioyers to
Employees for injuries not resulting in Death)of the Massachusetts General laws Annotated,you may he liable forperson(s)
you hire to perform work kr yon 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 Amended.
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: 112 Audubon Road Leeds, MA 01053
The debris will be transported by: American Installations
The debris will be received by: Waste Management of New England - Chicopee Lanfill
Building permit number:
Name of Permit ApplicantliAmerican Installations
6/24/17 Wfra l.l.(.( I
Date Signature of Permit Applicant
City of Northampton
`!d Massachusettsti
t Ef�4 .
D212 Mains OF BUILDING INSPECTIONS1ui1dinq2
�+ : 212 Main Street •o Municipal building `� a
,._ aoethempton: !A 01060
j144-IPSO
Property Address: I I'Audubon Road Leede MA 01053
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley,MA
Phone: 413-552-0200
Property Owner
Name: Alan tb Anne Evons
Address: 312 Audubon Road
City, State: Leeds, MA 01053
I, American Installations (contractor) attest and affirm that the budding I intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that f have
provided the property owner with a copy of this affidavit.
Contrt r4nt re // G, t
Date t/ j JS
6124/17
`
� i,, wwwAmemmrinnallatloncmm
BBB B.
IMSTierovic
• Conn
Licensed&Insur
MA CSL It:106178
American Installations MA Registration tl 175981
130 College Street Suite NO,South Hadley,MA 01075•Office1413)552-020O fax:74131552-0202 •Email:suppod®<merlonInstallatlons.com
Evans,Alan and Anne 6/17/2017
112 Audubon Road Leeds MA 01053
.a
413 2379045 al.evans@comcast.net mw
17-1502 pm 451708
Otte
Quantity Unit Unit Cost Total
Air/Dun Sealing
AIR SEALING 2 man hour $ 85.00 $ 170.00
WEATHERSTRIP DOOR&ADD SWEEP 2 each $ 80.00 $ 160.00
Air/Duct Sealing $ 330.00
Air/Duct Sealing Incentive $ (33000)
Air/Duct Selaing WS Balance $ -
Weatherization
WALLS-WOOD-SIDED 4"CELLULOSE 1,340 sqft $ 1.95 $ 2,613.00
Total Weatherization $ 2,613.00
Weatherization Incentive $ 1,959,75
SUMMER $ 100.00
Total Project $ 2,943.00
Total Utility Contribution $ 2,389.75
Total Customer Contribution $ 553.25
WARRANTY American In stallatems,LLD will provide the above stated Mmemener with a 2 year workmanship va rremy.
American Amelatwnebrhtiona nattal rorany aoposestated sire all material and etre to complete the above scope of work in accordance web the above specifications and all bea I and state building
ACCEPTANCE OF PROPOSAL:The above prices,specifications and TOTAL CONTRACT VALUE= $ 553.25
conditions are satisfactory and are hereby accepted.You are
authonzed to do work as specified.Payment wit be 1/3 down prior to Down Payment= $ 184.00 CKG
startwork.
swL oiupon Completion.and balaner due upmpletlon. PAID
3Stibin _ Balance Due Upon Completion= $ 369.25
" ,,,M 6/17/2017
.�..Gar` et TM rett Demers 6/17/20 17
•
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 CUSTOMERS)NAMED ON THE REVERSE SIDE,HEREINAFTER REFERRED TO AS'CUENT',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 SUBJECTTO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION.
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.
(185.6 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 FAIUNG TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY
HAVE THE RIGHT TOA 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.ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS OF SUCH EQUIPMENT AND
PRCOUCTS.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 ORDERTOACT1VATE SUCH WARRANTIES.
6.THEQUOTATION 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.
7.THE OMPANY'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
DUE TOME COMPANY'S NEGLIGENCE.
S.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 (ON 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.IFA - DEFICIENCY OR HAZARDOUS MATERIAL IS
ENCOUNTERED PRIOR TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING,COMPANY WILL TRY TO ASSIST CLIENT EWHIN THE COMPANY'S MEANS AND CAPABILITIES
TO CORRECT THE PROBLEMIS)ON A TIME AND MATERIAL BASIS.C 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 AND/OR DAMAGES,INLCUDING BUT NOT UMITED 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 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,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,HAIRUNE FRACTURES IN CONCRETE OR BLAQROP 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 102A OF THE GENERAL LAWS IS REWIRED 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 PAYMENTSCHEDULE,CANNOT BE CHANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED BY BOTH THE
COMPANY ANOMIE 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.
IS.THIS AGREEMENT,AND ANY WARRANTY(5)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 RE
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 THE CLIENT COULD RESULT IN A 5%RE-STOCKNG
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 IT IS 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 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 ENFORCEBILDY 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 ASS GNED 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 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.AN INSTALLERS,LLC IS NOT AN AGENT OF ANY UTLLRY 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
Is l Department of Industrial Accidents
W!=e Office of Investigations
1/4='qip;e '.irts r, 600 Washington Street
Boston,MA 02111
www.nurss.gov/dia
Workers' Compensation Insurance Affidavit Builders/Contractors/Electrieians/Plumbers
Applicant Information Please Print l,elahly
Name(Business/OrganExatiowtndividuai): American Installations,LLC
Address: 130 College Street,Suite 100
City/State/Zip: South Hadley,MA 01075 Phone ti: 413-552-0200
Are you an employer?Check the appropriate box: Type of project(required):
I. I am a employer with 46 4. 0 t am a general contractor and t 6. 0 New construction
employees(full and/or part-lime).' have hired the sub-contractors
2.0 lam a sole proprietor or partner- listed on the attached sheet.l 7. 0 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 area corporation and its 10.0 Electrical repairs or additions
required.) officers have exercised their
3.0 1 am a homeowner doing all work right of exemption per MGL I I.D Plumbing repairs or additions
myself(No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs
insurance required.(! employees. (No workers'
temp.insurance required.) 13.[ Other Insulation
ra
`Any applicant dm checks box NI must also fill out the section below showing their workers'compensation polky intormalion.
t I Iumaowners who subsea this affidavit indicating they arc doing an wort and Nm bite outside cuniractos must submit a new atrMava indicating such.
eermins cors obi check this box mut attached an additional sheer showing The name of the subcontractors and then workers comp.policy information.
l am an employer that is providing workers'compensation insurance formy employees. Below is the policy mrdjabsite
information.
Insurance Company Name: Guard Insurance Companies
Policy 1$or Self-ins. Lic,it; AMWC731485 Expiration Date: 09/04/2017
1
Job Site Address: ` � • son - city/slate/zip:
city/slate/zip: 1 tel5r Mk 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form Ma STOP WORK ORDER and a fine
of up to$25000 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
Sianawrei)S-'.�trrrdl.4. /t/��} C�L�W tau Date' (2_199. 11-*
Phone b: (/ 413-552-4200
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/Lieease# _
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 it:
ACORa CERTIFICATE OF LIABILITY INSURANCE IKMUN¢i6'
THE 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. TIES CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 51SDRER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder Is en ADDITIONAL INSURED,the polky(M)must be endorsed N SUBROGATION IS WANED,subject to
the Mimi and condtons of the pMIIN,Certain polkas nay require an endorsement. A statement on this certificate does not corMt rights to the
certificate holder In[leu of such endorsement(s).
PRODUCER 1C rtACT Linda PONBre
slabber at Grimall ^oat (413)586-0111 --FAX (41315e6-un
8 North King Street 20.erke 1powera0Mebberandgrinnell.ca
ueoRono uMRaae -...t__hues
Northampton MA 01060 NsuRERAYMployers Mutual Casualty
wYUPdO A6sugaaaoxerkeh4rM Hathaway HOARD Ina. Co.
American Installations, LLC IIURER C:
Attn: Wee 4 Susanne Couture 0:
130 College Street, Suite 100 mamma: ,..
South Badley SLA 01075 Mars F:
COVERAGES CERTIFICATE NSAABERS6aster SMp 9-2017 REVISIONN4MBER:
TMS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE AMY 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,LEEITS SHOWN MAY HAVE RFFN REDUCED BY PATO CHUMS.
A TYPE OE INWMXCE YaMrr— POLICY WaaE0. ..YYm I 'I'x'a MMra ._
COMIERCML GENERAL UM/UTE EACH OCCURRENCE 1.000:000
' µ{E TORE/min 500,000
A X CWMSMADE 1 i OCCUR ! a9E51Ee Oft2M
X Liquor Liability 503535217 9/4/2016 9/1/2017 MED VP(Aft amjaml) 10,000
PERSONNHAPnNJURY 1,000,000
GEN'LAGGREGATE LIMB APPLIES PER' GENERAL AGGREGATE 2,000,000
8POKY: JEST ;'LCC PgIX4CI5-CLAMP MUG 2,000,000
DINER:
AUTOMOBILE LMMLnV C MMED SINGLE tic 1,0000,000
A ZANY AUTO ODDLY:HAMY?P c ers,A) ...
ALL DYMEDSCHEDULED
[AUTOS xNo 543533217 9/4/2016 9/4/201.7v2
BODILY INIURE(PmaML)
HONO AUTOS X[AUTO En aftSift
I _. _. 0.000
AP9ek
A 8 ONa9EuW.
lE I 1.OCCUR EACH OCCURRENCE 1,000,000
EXCESS WaCLMMSMADE AGGREGATE 1,000,000
i— X50353S217 9/4/2016 0 4/2017
ONRETENTION 10,000 Y
AMDaMPUMERS WORKERSCONIM®UMW r1618RTE ERH
ANY%MyaETORNAIRIERIEXECmNE YIN Et EACH:CCICEM 500_,000
OFFICER/NEWER EAC Icc03MIA II
B lmianteom In a�Nyl( I Ii1A1PC609917 9/4/2016 9/4/2017 EI DISEASEE-fA EMPDYA 500 000
avi[DESCRIPTION OP OPERATIONS Mier I I EL SASE- OMIT 500,000
A Commercial Proper EY [513535217 9/4/201.6 0/4/2017 :awnlaYNpm 020,000
I Ia.eawSLOW $40,000
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF 1HE ABOVE DESCRIBED POLICES EE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL EE DELIVERED IN
ACCORDANCE'MHT THE POLICY PROVISIONS.
RUTIOIomD REPRESENSMrvE
Kevin Joyce/LHP ACS?e._�`
01988-2014 ACORD CORPORATION. AB rights reserved.
ACORD 16(2014/01) The ACORD name and logo are registered marks of ACORD
I104025rmunn
Unrestricted-Buildings of any use group which
ip Massachusetts -Department of Public Safetyless
a
Board of Building Regulations and Standards
tusthan 35,000 cubic feet(99101)of
enclosed space.
Cnmtruction Suneivisor
License:CS-708178
WESLEYCOUTIIjtEs n f�•rt,
166 NOB7H MAEII P ..
South Hadley M Ot '
rs .""4Failure to possess a anent edition of the Massachusetts
( State Building Code Is cause for revocation ofthis license.
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J,(, ini sinner ,n E12912lon Fa Des Licaning in/nmalbn ewe wvAtMsss.Gw/nP5
Commissioner 09r2ar2017
C2 ,e, .04 6nwea/f o/C/(6oaeAiuse&
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: LLC
AMERICAN*STALLATIONS.LLC. Ragas mUon: 775982
130 COLLEGE STREET$UITE 100 E>�raBon: 0812812019
SOUTH HADLEY,MA 01075
Update Address and return card. Mark reason for change.
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. ___,y' HOME IMPROVEMENT CONTRACTOR Registration valid for individual If found
only
TYPE:LLC before the expiration date. dround raWmlo:
r I En) Office of Commuter Affairs end Business sonly R. tMflon
I 175062 08^282018 scenic) Plaza-Sune5170
ERICAN INSTALLATIONS,LLC. Sector,MA 03116
WESLEY COUTURE UR..:' A--- l /"/
v130 COLLEGE STREET SUITE 106
SOUTH HADLEY,MA 01075 without signature