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12C-098
42 MORNINGSIDE DR BP-2018-0995 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 12C-098 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 Permitil BP-2018-0995 Project# JS-2018-001807 Est.Cost: 52940.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sp. ft.): 24872.76 Owner: LEE SEWHAN&MIHYUN Zoning: SRI]10)/WSP(110)/WP(78) Applicant. AMERICAN INSTALLATIONS LLC AT. 42 MORNINGSIDE DR Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:4/3/2018 0:00.00 TO PERFORM THE FOLLOWING WORKATTIC 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 Occuoancv Signature: FeeTvpe: Date Paid: Amount: Building 4/3!2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner RECE 'fr Deparhnent use only Ci of Northampton Status of Permit NOfl`YgAi�°N W 0'pS] Iding Department Curti GidlDrivewey Pemdt 212 Main Street Sewer/SepticAvallab7ity Room 100 WatarAV.9'Avallab*. Northampton, MA 01060 Two sets of Structural plams phone 413587-1240 Fax 413-567-1272 PlnrisHe Plans Oth 5pedfy APPLICATION TO CONSTRUCT,ALTER,REPAIR RENOVATE OR DEMOLISH JA ONE QWyOR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION LJr- — { 0 ' ` -`5 1.1 ProoertrAddress: This section to be comple office Map Lot_ ) q Unit. 42 Morningside Drive Zone Overlay District EM St Distrlet CB District SECTION 2-PROPERTY OWNERSHIPIAUTHOR17ED AGENT 2.1 Owner of Record: Sewhan & Mihyun Lee 42 MorninDrive Name(Print) ""!Ae21541 .See attached Telephone Signahne 22 Authorized Agent- American Installations 130 College St., Ste 100 South Hadley,MA 01075 Neme(Pmt) Curtest Negiq Add -. x 413-552-0200 Signeoae t Telephone SECTION S-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only oonipteted by pennit applicant 1. Building $2940.00 (a)Building Penn&Fee 2. Eieelrical (b)EsSmated Total Cost of Construction from 3. Plumbing BugEing PermR Fee 4. Mechanical(HVAC) 5.Fre Protection 6. Total= 1 +2+3+4+5) $2940.00 Check Number This Section For Official Use Only Date Bolding PertNt Number. Issue: Signature: Building Commissioneranspedwol Bu Mugs Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Imomplete Into matbn Existing Proposed Required by Zoning Thucdumn W be filed in by HUBS BDc)� Lot Size Frontage OCL— Setbacks Front 1 1= Side L:= R:= L:F=FCCI i- Rear Building Height J Bldg.Square Pooling. Open Space Foomge --ll k ([.a ena ndom bN6 a.peved CJ U �� C� CJ #ofPar6io S ces CJ CJ velum¢&lumdm) A. Has a Special Permit/Variance/Finding over been issued for/on the site? NO O DONT KNOW O YES Q IF YES,date issued:I j IF YES: Was the permit recorded at the Registry of Deeds? _ NO O DONT KNOW O YES O IF YES: enter Book J Page and/or DDcument#L B. Does the site contain a brook,body of water or wetlands? NO O DDNT 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: L E. Will the consbuction activity disturb(dearh0,gading,excavation,or filling)over t am or Is K part of a common plan that will disturb over t acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is requlred. SECTION 5-DESCRIPTION OF PROPOSED WORK Icheck all applicabl.1 New House ❑ Addition ❑ Replacement Windows ARerstion(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bing. ❑ Demolition ❑ New Signs lo] Delis iO Sidingol Otherigfj Brief Description of Proposed Work: Attic and basement 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 fiousinD complete the foliowina: a. Use of building:One Famiy. Two Family Oher b. Number of rooms in each family unit Number of Bathrooms c. Is theta a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? I. Method of healing? Fireplaces or Woodstoves Number of each_ g. Energy Conservation Compliance. Masschack Energy Compliance farm attached? h. Type of construction 1. Is conshucdon within 100 iL of wetlands?_Yes _No, h construction within 100 yr. floodplain_Yea_No j. Depth of basement or eager floor below finished grade k. Will building conform to the Building and Zoning regulations? _Yes_No. I. SepOCTenk_ COy Sewer_, Private well_ City water Supply SECTION 7a-OWNER AUTHORIZATION•TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1. as Ovmer of the subject prop" hereby authoris American Installations to act on my behalf,in all matters relative to wok authoitied by this building penrit appfxatipn. See attached 3/29/18 signature of Owner Date I, American Installations asOwrier/Authorized Agent hereby declare that the statements and Information on the foregoing application are true and accurate,m he best of my knowledge and belief. Signed under the pains and penalties of perjury. American Installations Prim Name 3/29/18 Signature of Ow#gent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable ❑ Nameot Liearue NOMer. Wesley K. Couture 106178 Ucame Number 130 College St., Ste 100 South Hadley, MA 01075 _ 9 29119 Address Expiration Date �tLk Cy.Tnvv. 413-552-0200 Swam _ 9.Registered Rahe Improvement Contractor. - Not Applicable ❑ Wesley Couture _ 175982 Company Name Registration Number American Installations _ 6/26/19 Address Expi Avon Date 130 College St., Ste 100 South Hadley, MA 01075 Telepbane 413-552-0200 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,4 2SC(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 budding permit _ SignedZradevitAtteched Yes....... H No...... ❑ 11. -Home Owner Egemdon The current exemption fm"homeowners"was extended to include Owner-ocumied DwelUnn ome(1) a two(2)families and to allow such homeowner to engage an individual fur hire who does not possess a license,provided that the owner gets as supervisor.CMR 780, Sixth Edition Section 1083.5.1. Definition of Homeowner,Parson(s)who own a panel of land on which helshe resides m intends to reside,on which there is,or is intended to be,a me or two family dwel ing,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 shag not be considered a homeowner. Such"homeowner'shall submit to the Building Oficial,on a form acceptable to the Building Official,that he/she shag be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence am the job site will be required from time to time,during and upon completive of the work for which this p¢mitis issmd Also be advised that with refscisco to Chapter 152(Workers'Compensation) and Chapter153(LiabilityofEmploy=m Employees for injuries notremlting inDeath)of the Massachusetts General Laws Annowed,you maybe gable forperson(s) you hire m perform work for you under this petmiL The undersigned'9mmcowner"certifies and essumee responsibility for compliance with the Side Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State ofidassachuseffs General Laws Anaotaw. Homeoaver Signature _ _ City of Northampton j Massachusetts ti S- `fes 3 DEPARTMENT OF RMLDZHO INSF roaS 212 win ateaet . N iclp. suilc iW qCS Norehempteu, I 01060 'FJ\ Property Address: 57 Mann Terrace Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley, MA Phone: 43-552-0200 Property Owner Name: Sewhan &Mihyun Lee Address: 42 Morningside Drive City, State: Florence,MA 1, 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 r Date 3129/18 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: 42 Morningside Drive Florence, MA 01062 The debris will be transported by: American Installations The debris will be received by: Waste Management - Chicopee, MA Building permit number: Name of Permit Applicant Wesley Couture 3/29/18 Wim . Cs� n Date Signature of Permit Applicant • mass save "•^'"°°'"""� PARTNER MR IS'o:IAi15 j, American Installations wwwAmer12aninstzllations_com 130 CdkR 54eM3uXe 1W.souM Wdry.MP O1N3�OH¢:N13133ELEW is+:M1A X14342�Em 1 tu00ur®PmntaMnaWlaema[wn Customer Name:Sewhan Lee Email:Not provided Phone:716-238-1541 Premise Address:42 Morningside Dr Northampton,MA 01062 Project ID:3388888 Date:March 23,2018 Job Description Measure Description. ouantity 0* Total Cost Cost Rim Joist- 6" Fiberglass Batting 114 SF $307.80 $76.95 Attic Floor- 10"Open Blow Cellulose 512 SF $972.80 $243.20 Damming 36 each $86.04 $21.51 Kneewall Wall - 2" Thermal Barrier Polyiso 20 SF $95.60 $23.90 Hatch - 2"Thermal Barrier Polyiso 2 each $92.56 $23.14 Attic Floor- 6"Open Blow Cellulose 204 SF $330.48 $82.62 Vapor Barrier - 6 mil Polyethylene (on AS job) 336 SF $329.28 $0.00 Door Sweep (on AS job) 3 each $75.93 $0.00 Exterior Door Weather Stripping (on AS job) 3 each $90.21 $0.00 Air Sealing at Estimated 62.5 CFM50 Per Hour 6 hr $555.48 $0.00 Project Total $2,936.18 Weatherization incentive ($1,413-96) Air sealing incentive ($1,050.90) Total Program Incentive -$2,464.86 Customer Total $471.32 wnaw.v-v.a"e".a".a..n.[°^>s Mn c•o:aE tnr.n^«.r,xa na7ew"...an,r xa..•¢E�w;4..«•,Hr. - n::da°Nr.Lc ne,m=4.^4<x+wwsm Mi^.,.mi.mim°.n.°md«r3re Ooxst¢.e°•+°.EI".[[°,m°[e Mn.naan°x w«aR:ao^:."amu[a,m u.re dare maexoM.°,m^roroi Ea,rc.=n vam.,..r=o-e m,..". ecE o= .ao=ou: -re e— r-ti, :¢.ns.Mro^: a^a r¢im. : .¢ -o.A.coarwacvnt4e-s 471.32 150.00 W cc ..n4"2n eo."o•^.to na^^•.."n,."°n.ia,ra^e^e^4« c°r,Mea°" vno ea.^¢n<un^^�m4ie,e"- s 321.32 lit— n^4rmo.M.1ra^[t =Lec Sewhan &Mihvun t4Ew ,q � ov, 3-23-18 xmr«.�trroeto, R-Zani ts3m 'S/� -/ 3-23-18 THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE 51DE OF THR PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED. THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERIED TO M"COMPANY",AND THE CUSTOMERLSI NAMED ON THE REVERSE SIDE,HEREINAFTER REFERRED TOM"CLIENT',AND WILL BE SUBJECT TO ALL APPROPRIATE IAY6, REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONN RETREAT RESPECTIVELY AS WELL AS ALLLOCAL JURISDICTIONS. THE FOLLOWING TEAMS AND CONDITIONS A60 APPLY 1, THIS AGREEMENT ISSUBIECTN THE APPROVAL OF A MANAGER OF THE:OMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION. 2, SHOULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGREEMENT,CH/AGES SHALL BE ADDED FROM TILE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(1-1/2J PERCENT PER MONTH.(18%PER ANNUM,WITH A MINIMUM CHARGE 01$2.W PER MONTH,AND IF PLACED IN THE HANDS OF AN ATTORNEY OR COLLECTION AGENCY FOR COLLECTION,ALL A70RNUV FEES,EXPENSES AND COSTS OF COU CTION SHALL BE PAID BY THE CLIENT. IN ADDITION,CLIENT UNDERSTANDS THAT IN FAILING TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY HAVE THE RI TNT TO A LEIN ON THE PROPERTY. 3. THE COMPANY AGREES THAT WHEN DECAYS BECOM E KNOWN TO THE COMPANY,THE COMPANY WI LL AOVI5E THE CLIENT AS SOON AS REASONABLE. <. COMPANY AGREES THAT,NOTWITHSTANDING ANY AGREEMENT FOR MJTERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY IS RESPONSIBLE TO CLIENT FOR COMPLETION OF ALL WORK DESCRIBED IN A TIMELY AND WORKMANLIKE MANNER. 5. ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTUR ERS OF SUCH EQUIPMENT AND PRODUCTS. UNDER SUCH MANUFACTURER'S WARRAT.TIED,!HE CLIENT MAYBE REQUIRED TO REGISTER OR MAIL INA WARRANTY CARD OR OTHER EVIDENCE OF OWNERSHIP AND USE OF SUCH EQUIPMENT AND/OR PROC UCTS N ORDER TO ACTNATE SUCH WARRANTIES. 6, THE QUOTATION ON THE PAGE HEREOF DOES NOT INCLUDE EXPENSES UR CHARGES FOR BOND OR INSURANCE PREMIUMS OR COSTS BEYOND NORMAL I NSUMNCE COVERAGE ANY SUCH ADDITIONAL EXPENSES,PREMIUMS OR COST SHAT L BE ADDED TO THE TOTAL AGREEMENT AMOUNT. J. THE COMPANY$LIABI LITY FOR CLAIMS ARISING OUT OF THIS AGREEMEN T SEAL L NOT EXCEED THE TOTAL AGREEMENT PRICE EXCEPT TO TH E EXT ENT THOSE DAMAGES ARE PROVEN TO BE SOLEY DUE TO THE COMPANY'S NEGLIGENCE. 8, DURING THE DURATION OF THE WORK,THE CLIENT'S HOMEOWNERS IN'ORAN'D 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 DEFICI ENCIES OR FAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS. E G.WOOD ROT,MOLD,ASBESTOS,NAIL POPS,DUCTWORK AND CONNEC fIONS,PLUMBING AND VENT PIPES,DECKING OEFLUCALON,ETC.IFA 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 TO CORRECT THE P10611 MIS)ON A TIME AND MATERIAL BASIS. CLIENT AGREES THAT SUCH CONDITIONS ARE UNAVOIDABLE BY THE COMPANY AND SHALL NOT BE CONSIDERED A VICLATICN 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 HOUI THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES,INLNDING BUT NOT LIMITED TO MOLD GROWER.ARISING FROM THE PERFORMANCE OF AIF SEALING WORK BY THE COMPANY AS A 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 PND/OR AFTER THE PERFORMANCE OF WQRK BY THE COMPANY 12, REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,ROOF JACO 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 ANDCEILINGS,FLOORS,TNM GUTTERS,DOWNSPOUTS,EXISTING SIDING AND WINDOWS,MOM,OIL DROPLETS IN DRIVEWAYS,HAIRLINE LANE TUBES IN CONCRETE OR BLACKTOP DRIVES AND WALKS,OR DAMAGE TO PLANTS OR SHRUBBERY, IF EXCESSIVE DAMAGE IS CAUSED BY COMPANY COMPANY WILL REPAIR OR REPLACE DAMAGED AREA ONLY AT COMPANYS EXPENSE, 16. THE COMPANY UNDER PROVISIONS OF CHAPTER M2A 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 WORD DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT CRANING OR INSPECTIONAL AGENCIES,AUTHORITIES,OR INDIVIDUAL. 15. THI5 AGREEMENT,I NCWDING THE PROVISIONS RELATING TO PRICE AND PAMPA ENT SCHEDULE,CANNOT BE C HANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED BY BOTH THE COMPANY AND THE CLIENT. 16, ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATION NC T WRIIIEN 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 WRII3ENCONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN. 18. THIS AGREEMENT AND ANY WARRANNISI PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY 09 WITH THE WRITTEN PERMISSION OF THE COMPANY. 19. IF THE CLIENT FAILS TO PERFORM ITS OBLIGATIONS HEREUNDER OR TERLAINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT SHALL BE LIABLE FOR DAMAGES FOR THE GREATER OF THE COMPANV'SACTUAL DAMAGES OR 25%OF THE AGREEMENT FOR RESTOCKING FEE. 20 ANY CHANGES TO MATERIALS BY THE HENT(BRAND,STYLE COLOR ETC I ALII N SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT IN A 5%RE-STOCKING FEE BASED ON THE COST OF SAID MATERIAE. 21 THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALI.PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL ME 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 Sl CH 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 VAUDLY AND ENFORCEBILITY OF THE REMAINING PROVISIONS OF THIS AGREEMENT SHALL NOT BE AFFECTED THEREBY. 23. ARBITRATION:IN THE EVENT THE CLI ENT AND COMPANY HAVE A GREG EE REGARDING ANY OF THE TERMS,CONDITIONS,PROVISIONS,OR PERFORMANCE OF THIS AGREEMENT,THE PARTIES AGREE TO PLACE THE MATTER INTO ARBITRNTION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION ASSOCIATION TO RESOLVE THEIR DISPUTE. 26. ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM TI AT IS PART OF A STATE SPONSERED UTILITY PROGRAM D 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 UTINTY PROGRAMS MAY BE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE. 25, AMERICAN INSTALLERS,LEC 15 NOT AN AGENT OF MY UTILITY COMPANY OF OTHER VEN00R WORKING BAL THROUGH,DR UNDER THE MASS SAVE'ENERGY PROGRAM. 26. CLIENT IS REPSONSIBLE FOR THE PAYMENTOF ANY AND ALL FEDERAL,STA TE,OIL LOCALTAXES FANFARE APPLICABLE TO THIS AGREEMENT The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations wi 600 Washington Street Boston,MA 02111 wwiv.mass.govIdin Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Businns/Organiz Llowindividua0: American Installations,LLC Address: 130 College Street,Suite 100 City/Stale/Zip: South Hadley,MA 01075 phone Or: 413-552-0200 Are you an employer?Check the appropriate box: Type of project(requiredy I.U 1 on is employer wnh 46 4. ❑ I am a general contractor and 1 6 ❑ N ew construction employees (full and/or part-time)' have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in anv capacity. workers'comp. insurance. 9, ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.U I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§I(4),and we have no 12❑ Roof repairs Insurance required.]I employees. (No workers' 13J]Other Insulation-- comp. insurance required.) -' ----- 'Any applicant thin checks box BI must alto rill out the section below showing their worsen'compmwnipr p.licy inhmp, i n. t I Inmeuwnen who submit tM1is vmdavit mJrcming may ora Juing oll work end thrn M1im onside contractors mull subinil a nvw alliJavit indicaing such. :llunbaclors Nat chcM1k this box must eltachN an additional sheet showing the name of tM subsommnun and IMir workers'camp.polity inPormaliun. l um an empiuyer that is providing workers'compemwion imsurance for ttty employees. Below is the poltcy Mai she informmio,c Insurance Company Name: Guard Insurance Companies Policy 4 or Self-ins. Lic.# AMWC731485 _.. Expiration Date: 09/04/2018 lob Site Address: LAI M(5-Yxw.vsS/Vkci-t �n.U.>� City/Slate/Zip:.�q �1a:vx,CA M{t O[0(p 2. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dale). Failure to Secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penaldes in the form of STOP WORK ORDER and a fine crop to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. 1 no hereby cePrvrii/y under lbe points a/nJd penuffleess,afperjurr that the information provided above is true and correct. D 5�0/JLd//IinA �1- ( .fH1.7.C✓2A— Ie: c Phone q: 413-55 -0200 Official use only. Do not write in this area,to be complered by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Citvfruwn Clerk 4. Electrical Inspector 5. Plumbing inspector 6.Other Contact Person: Phone#: ®, Coonbnweakh of Massachusetts Constneduan Supervisor Division of Professional Licensure UntelbF.ted-Buildings of any use group wtdch contain Board of Building Regulations and Standards lsstM 38,000 cubic feel(1101 cubic meters(ofetldossid Construction Supervisor she' CS-106178 Expires:09/29/2019 WESLESOUTH COUTURE 218 LATHROPSTREET - BOUrMHI1DLLYMI101078 Fallure so posses a currant edition athe Masuehuse0s State Building Code Is cause for reaofeflon OI MM Scause. FQ I los,Nllpl ffiWtMla 9Ctilfe COnlmlfrlOn@f Call(617)727-1200 or vlek wwwmae.gov/dpl n�/ ('r-f-I 7J7tllttlrlfYt�f1 t � 71JJftlfttlJP �J 1A Office of Consumer Affairs and Business Regulation >, " 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: LLC AMERICAN INSTALLATIONS,LLC. Registretlon: 175982 130 COLLEGE STREET SUITE 100 Expiration: 00/26/2019 SOUTH HADLEY,MA 01075 UpdateAidnisaandreturncard. Markraseonforchange. s Al a 201A-0 11 n Addr^_ r_f n—e^e._.el 11 Employment [J Lost C.rd Mite of Consumer AMairs a Business Reaulaeen HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:LLC before file exPlradon date. 0 bund return to: ? Reolstratlan ESplrai Office of Consumer Affairs,and Business Regulation 175982 0&26/2019 to Park Rua-Suke 5170 AMERICAN INSTALLATIONS,LLC. Boston,MA 02116 WESLEY COUTURE 130 COLLEGE STREET SUITE 100 SOUTH HAOLEY,MA 01075 Undersecretary Nilid without signature t valid ACOCERTIFICATE OF LIABILITY INSURANCE DA�'M Li CERTIFICATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,the policy(iss)must he endorsed. If SUBROGATION IS WAIVED, subject to Me 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 endorsement(s). cc PRODUCER NRME:XTA T Linda POp¢x4 Webber 6 GrinnellP1pxE , (413)586-0Per 111 a'p131 sa6-6451 8 North ruing Street ADonis :lpowarsUVREED randgrinnell.com INSUREINS)AFFORDING COVERAGE NRICM Northampton NA 01060 IXSURERAEm to rs Nutual Casualty INSURED INSURERS Berkshire Hatliawa GDARD Ins. Co. American Installations, LLC INSURERC: AtLR: Was 6 So2anne Covtur¢ INSURERD'. 130 College Street, Suite 100 INSURER E' South Hadley HA 01075 1 INSURER F' COVERAGES CERTIFICATE NUMBERidaster MP 9-2018 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. NOTVMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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. INSRLTR TYPE OFIXSURANCE U POLICY EFF POLICY ELP POLICY NUMBER MMD MW LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 A R CLAIMS-MADE ❑OCCUR PREMISES UP.owrrtee. $ 500,000 503535217 9/4/2017 9/4/2018 MED E%E(Any one person) S 10,000 PERSONAL S ADV INJURY $ 11000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 % ROUOV�jECT OLOC PRODUCTS-COMProPAGG S 2,000,000 OTHER AUTOMOBILE IIPBRIttM.oerBINEDe IN LIMITg 11000,000 IE A ANY AUTO POORLY INJURY INJURY(Px(arson) 8 AUTOS EO '4 AUTALL OSULED SE353521] 9/4/2017 9/4/2010 BOOILY INJURY Joer awUant) $ R HIREDAUTOS R AUTOSMEO �MAGE $ pip IS= $ 8,000 R UMBRELLALIABOCCUR EACH OCCURRENCE E 11000,000 A EXCESS LIAR CLAIMS.. AGGREGATE IS 11000,000 DEO I X 1 RETENTIONS 30 000 Sd3535217 9/4/2017 9/4/2018 $ WORNERS COMPENSATIONPER TX- AND EMPLOYERS MERELY Y)N x STATUTE ER ANY PRCPRIETONPARTNEWEXECELLVE ❑NIA E.L.EACH ACCIDENT E 500,000 H OFFICERMEMBER EXCLUDE07 (Mandatory In Np VRML 60991] 9/4/2017 9/4/2018 E L.DISEASE-EA EMPLOYE $ 500,000 Mp —S,J. CRUTIONOFOPERATIONStekw EL.DISEASE-POLICYLIMIT $ 500,000 A Con®®rcial Property 5A3535217 9/4/201] 9/4/2018 dedutCle 81 W4 DESCRIPTOR OF OPERATIONS I LOCATIONS I VEHICLES LACORD 101.Additional Re—Ke SCM1eOJIC may Ee MaCNen N more Spain h mqul2Hl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence Of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Kevin Joyce/LMP �� -- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025nm4Dn