43-054 89 WESTHAMPTON RD BP-2018-1201
GIS n: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:43 -054 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-2018-1201
Proiect9 JS-2018-002148
Est.Cost:$5900.00
Fee:$65,00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group AMERICAN INSTALLATIONS LLC 106178
Lot Size(sp ft.): 30971.16 Owner. ADAMSKI JULIE
tonin : Applicant: AMERICAN INSTALLATIONS LLC
AT. 89 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 Liability
SOUTH HADLEYMA01075 ISSUED ON:511612 01 8 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 p 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:
FeeTvue: Date Paid: Amount:
Building 5/16/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RE Department use oily'
No mpton stalusof Permit
SHIN' D artrnent Curb CytlDrlvewey Permit
MAY 1 4 201 12 an Street Se". :deeptic.Avanabnily
om 00 Wetir/Wen•Ayenab*
Nort n MA 01060 Two Sets of st odturel Plans
�PT� MR40 Fax 413.537-1272 FmtlShe-Plehs
K 0 T
WimSped(y
APPLICATION TO CONSTRUCT,ALTER,REPAIR RENOVATE OR DEMOLISH A ONE
OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION a/ 3-1.)D
1.1 Proaarly Adtlress: This section to be completed by am"
89 Westhampton Road Florence, MA 01062 Map - I Lot U S7 Unk.
Zone Overlay DistrkC
But St District- CB David
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGFM
2.1 Owner of Record:
Julie Adamski 89 Westhampton Road Florence, MAO 1062
Name(Print) C mea Me""'Adtlrass:
(413) 210-2457
See attached Telephom
signetue
2.2 Autharleed Agent-
American
gentAmerican Installations 130 College St., Ste 100 South Hadley, MA 01075
Name Irma) Cunmt Mating Address:
WIA _Q.,. k . Gwb cz. , 413-552-0200
Signature I Telephone
SECTION 3-F33MATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permite licem
1. Building 5,900.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from
3. Plumbing Building PermR Fee 00
4. Mechanleel(IdVAC)
5.Fre Protection
6. Total= 1+2+3+4+5 5,900.00 Check Number
This Section For Official Use Only
Sutiding Permit Numb Data
Signal �� �g
Building hebnemnspeclorof SuMinga Date
Section 4. ZONING Ali Information Most Be Completed.Permit Can Be Dentey Due IMampmte IMormatbn
Existing Proposed R� •'�..mA A.,zo�.ag �}�
mWMnmry be�kd m 4r
B Dvnmuot
Lot Size
Froutoge
Setbacks Front O O
Side L:0 R= L:=R= L_S
Rear j- 0
Building Height
Bldg.Square Footage �—� �—� % O L�
Opens Space Footage r� %
(ren nee minor bora A peed 0 u
#of Perkin S aces
Fill:
volume&laedoo
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES,date IssuediI
IF YES: Was the permit recorded at the Registry of Deeds? _
NO O DONT KNOW O YES O
IF YES: enter Book PageF and/or Documentif
L_
B. Does the site contain a brook, body of water or v ttands? 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 tocation: 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. Wal the construcdan activity disturb(clearing.grading,excavadon,or filling)over 1 acre or Is K part of a camman plan
thatwl9dlsturboverlacre? YES NO O
IF YES,then a Northampton Stoml Water Management permit from the DPW is required.
SECTION S.DESCRIPTION OF PROPOSED WORK(cheek all applicable)
New House ❑ Addition ❑ RaplecerdeM Windows Alteration(s) ❑ Rooting ❑
ar Doos
Accessory Bldg. ❑ Demolition ❑ New Signs [M] Decks Sldingg31 Odwr[&
W Desct=MProposed
Work;A fisc and basemen t insulation and air sealing Throughout
Atteragon of assfing bedroom_Yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _Yes No
Plans Attached Rog -Sheet
Ga.If New house and or addiHonYo existing homing,complete the following:
a. Use of buflding:One Famity Two Family Other
b. Number of rooms in each family unit Number of Bathrooms
Q Is there a garage atlachad4
d. Proposed Square footage M new construction. Dimensions
e. Number of stodes?
f. Method of heating? Fireplaces or Woodstowes Number of each
g. Energy Conseweflon Compliance. Masacheck Energy Comptienm torn attached?
h. Type of construction
1. IewnsWcgonwOhinlOOfLofmUands?_Yea _No. Isconsbuctionwithln100yr. goudpiain Yes_No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulatiom? Yes_No.
1. SepOc Tank_ CitySewar_ Pdvate well_ City rater Supply_
SECTION 7a-OWNER AUTHORIZATION.TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Julie Adamski .as Owner of the subject
Property
herebyautiwrize American Installations
to act on my behalf,In all matiws rela0ve to work authorised by this building permit appgcetion.
See attached 5/11/2018
Slpmlue of Owmr Dale
I. American Installations as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and aocurete,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
American Installations
PM1d Name
A) la� -• • , 5/11/2018
SI ansa of enl 6.C `^-� Date
SECTIONS-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: NotAppllcable ❑
Name of Uemue Noiaer: WesleyK. Couture 106178
Dcense Number
130 College SL, Ste 100 South Badley, MA 01075 9/29/19
areae /�� ,-,� Exwsrsom pale
k - l/YLLW.V 413-552-0200
SlonaN— rem^ Tebphmm
e.Reals{. ' -N.i.::.!'•�rova'inedt-.ontro,Jor... . _ Not ApOcable ❑
Wesley Couture 175982
Comoanv Name Registration Number
American Installations 6/26/19
Address Expiration Oats
130 College St., Ste 100 South Hadley, MA 01075 Teleptmne 413-552-0200
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L C.152,§25C(6))
Workers Compensation Insurence affMavd must be completed and submdted with this appfcabon.Failure to provide this af8dav8will resu8
in the denial of the issuance of the building permit.
SIgnedAffidwitAttechad Yes....... 21 No...... ❑
11. Home Owner Exemption
The currant exemption fur"homeowsers"was extended to include Owner-oecuoled Dwellings ofone(l) or two(2)families
and to allow snob hoemownar to engage an individual for hire who dose not possess a license,provided that the owner acts
es sursaybar.CMR 780, Sixth Edition Section 1083.51.
DefiuDion of Homeowner:Person(a)who own a parcel of land on which he/she resides n intends to reside,on which there
is,or is intended to be,a one or two family dwelling attached or detached snucbues accessory to such use and/or farm
structmes.A heron who constructs more than we h In a two-year period still nothe considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building OfW 4 that he/she shag be
responsible for sU each work Performed render the bu ldion permit
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion ofthe work for which this permit is issued
Also be advised that with reference to Chapter 152(Workers'Compematim) and Chapter 153(1Sab0ity ofEmployers to
Employees fee injuries but resulting in Death)ofthe Massachusetts General laws Aonotated,you may be liable for persons)
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 Toning laps and State of Massachusetts General Laws Amounted.
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: 89 Westhampton Road Florence, MA 01062
The debris will be transported by: American Installations
The debris will be received by: Waste Managment of N.E. - Chicopee
Building permit number:
Name of Permit Applicant American Installations
5/11/2018 �� � t^SOAMA_.
Date Signature of Permit Applicant
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OBinLe° PARTNER
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Customer Name:Julie Adamski
Email:Not provided
Phone:413-210-2457
Premise Address:89 Westhampton Rd,Nodhampton,MA 01062
Protect ID:3404149
Date:April 24,2018
Job Description
Air Sealing at Estimated 62.5 CFM50 Per Hour 6 hr $555.48 $0.00
Exterior Door Weather Stripping (with AS hrs) 3 each $90.21 $0.00
Door Sweep (with AS hrs) 3 each $75.93 $0.00
Door-2" Thermal Barrier Polyiso 1 each $90.44 $22.61
Insulation Removal 200 SF $252.00 $252.00
Basement Ceiling-9" Fiberglass Batting 660 SF $1,861.20 $465.32
Hatch - 2"Thermal Barrier Polyiso 1 each $46.28 $11.57
Kneewall Slope -6" Fiberglass Batting 174 SF $370.62 $92.65
Kneewall Slope-2"Thermal Barrier Polyiso 174 SF $831.72 $207.93
Sheathing Access 3 each $120.06 $30.01
Attic Floor- 5" Open Blow Cellulose 420 SF $646.80 $161.70
Bath Fan - Vent to Root 1 each $141.30 $35.32
Aluminum Ridge Vent drift) 22 each $684.20 $171.05
Damming 28 each $66.92 $16.73
Project Total $5,833.16
Weatherization incentive ($3,644.65)
Air sealing incentive
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atisiaLmrVaMaehaeb/aveple0.Vcuarta4M1aluC[oNwM of KKefiee Varment �N,nearmex�[
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Customer Name:Julie Adamski
Email:Not provided
Phone:413-2102457
Premise Address:89 Westhampton Rd,Norbampton,MA 01062
Project ID:3404149
Date:April 24,2018
Total Program Incentive -$4,366.27
Customer Total $1.466.89
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Wranae 4/24/2018
ncMp gree Mintl 156nI Date
uvmmomr lruntl Garrett Demers ISBN Date 4/24/2018
IThe Commonwealth of Massachusetts
Department of In vestat Accidents
OOffice of Investigations
600 Washinglon Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Bus'ine,s/Drgani> tioWindividuap: American Installations,LLC _
Address: 130 College Street,Suite 100
City/State/Zip: South Hadley,MA 01075 phone 4: 413-552-0200
Are you an employer?Check the appropriate box: Type of project(required)
1.Lx] I am a employer with 46 4. ❑ 1 am a general contractor and 1 6. ❑ New construction
employees(full and/or part-time).' have hired the subcontractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.: 7. ❑ Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in anv capacity. workers'comp-insurance. 9, [] Building addition
[No workers'comp. insurance 5. ❑ We arc a corporation and its
required.( officers have exercised their 10.EJ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I L❑ Plumbing repairs or additions
myself tNo workers'comp. c. 152,§1(4),and we have no 12.E] Roof repairs
insurance required. t employees. [No workers' I3.®Other Insolation
p
cominsurance required.] '----"
^Any applicem nut checks box el most also fill ouubo section below showing their wodersomwenmtion polity inf anuaw.
t I eassivnom who submit this anidevh indicating nay use duan,nll work and den has omside canaacfrs musl submit a nnv Aralavit am,aing sod,.
%Cmuvitmx mat check this bon must ntuehed an additional sheet showing the name of the subKommewrs and dev workmi com,.hili y intmmoh.
tam an employer that is providing workers'rompensmion insurance for my employees. Below is the policy and job site
informmioa
Insurance Company Name: Guard Insurance Companies
Policy h or Self-im. Lis.h: AMWC731485 ___ Expiration Date: 09/04/2018___
Job Site Address: (00 Psi d City/State/Zip:�yr (a t0`R 61WZ
Attach a copy of the workers'campensotida 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form or u STOP WORK ORDER and a fine
of up to$250.00 a day against the violates. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify
9
rtify under the pains anjd penalties ofperjury that the information provided above is true and correct
Si.mature M/A. . (/
Phone h: 413-55 -0200
Official use only. Do nor write in this area,to be completed by city or town official
City or Town: Permit/License h
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone M:
Commonwealth of Massachusetts Construction Supervisor
®; Division of Professional Licensure Unrestricled-Buildings a any use group"Ich CDdUl
Board of Building Regulations and Standards less than 36,000 cubic fast(991 cubic meters)of encbsed
Construction Supervisor fie.
CS-106178 Expires: 09/29/2019 -
WESLEY COUTURE -
218 LATHROFrSTREET
SOUTH NADLEY MI1 0107a
ti Failure m possess a current edition string,Massadmsetrs
State Building Cade is cause for revocations of thba flowers.
For information about this license,
Commissioner (�(s•• Can(917)72741200 or Ask www.rmss.goWdpl
�'�J r'��� �Pa�yr�rrn�rrae{r�l� af�C��rr�.urrfr�seflt
/ Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: LLC
AMERICAN INSTALLATIONS,LLC. Registration: 175982
130 COLLEGE STREET SURE 100 Et�lratlon: 08/26/2019
SOUTH HADLEY,MA 01075
Update Address and return card. Mark reason for cMnge.
SGt O 20MLL11 0— Rene...-- rT 1 1
Addyn�e C.—__ FTn aymsM ❑mss!GPra
f OaiNeeOMEE IMPFIOWMMEWBCONTIFURCpTOulRetlenuse
Registration
eexpens for ted . If fo only
TYPE:LLC beforearefopi.Affle. ad,Bu nNm 1o:
r\..vlfr. $ 75982 DW26=1Expiratio0 10Office
Park Consumer Affalre sed Business Regulation
--�•' 1]5982 04-28I'1019 tO Perk Name-Suite 5170
AMERICAN INSTALLATIONS.LLC. Boston,MA 02110
WESLEY COUTURE
COLLEGESTREETSUITE 100
SO EV
U �thbut--
SOUTH HADL ,MA 01075 Undersecretary �valld lnthout signature
AcoR1Y CERTIFICATE OF LIABILITY INSURANCE DATE(MMODI
III8/14/201717
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 INSURERIS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certNkate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this CerlMcate does not confer rights to the
ce"I icate holder in lieu of such endomement(s).
PRODUCER We.E Linda Powers
Nahher c Grinnell PHONE (413)586-0111 Fuc No:14131506-6481
AL
B North Xing Street pppgEgg:1po3Pers@9re15herandgrinnell.com
INSUREMS)AFFORDING COVERPOE NNIC II
NorthaIDpton HA 01060 INSUREIRAIEsEPIPPRECS Ifutnal Casualty
INSURED INSURER.Berkshire Hathansay GUARD Ina. Co.
MAI... Installation., LLC INSURER G.
Attn: Nes 6 Suzanne COIIture EARSPER D:
130 College Street, Suite 100 IXSURERE:
South Hadley lM 0107$ INSURERF:
COVERAGES CERTIFICATE NUMBERMaeter Exp 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT 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.
MSM XMIRGIRMI� LICYEFF POLICY EVP UNTS
LTR TYPE OF INSURANCE POLICY NUMBER MWO MW
L GENEMLLJAMLITY EACH OCCURRENCE 5 3,000,000
AJ�OMNE
AIAOE OCCUR PREM7—�)
E 500,000
SD353541'1 9/4/2017 9/4
/2018
RED ) E 10,000
PERSY S 1,000,000
GEML AGGREGATE LIMIT APPLIES PER'. GENE1 21000,000
POLICY❑PROE]LOC PROAGG 1 21000,000
JECT
OTHER. LIMI
AUIOMOMLE LIABILITY RY,aWOenl $ 1,000,000
A ANY AUTO BODILY INJURY(Pe,Fxcon) s
ALLO MED X SCHENUCS DULED 5Z353521 9/4/201] 9/1/2016 SOLELY INJURY(Pe,armI E
NON-0NMEO PROPERTY WMAGE E
X HIRED AUTOS 7` AUTOS Px azEml
PIP-Sesk 5 8,000
R UMBRELLA LIAR OCCOR EACH OCCURRENCE E 1,000,000
A EXCESS
Use CLAIMSt1AOE AGGREGATE $ 1 000 000
OEO X RETENTIONS 30 000 5J353521] 9/4/2017 9/4/2016 §
WORNERSCOMPENSATONX STATPER H-
UTE ER
AND EMPLOYERS'UA91Utt
ANY PRCPRIETOILPARLHEWE%ECUTIVE YO MIA EL EACH ACCIDENT B 500,000
H lasmaoyOFFICERAMLal NeFIOWOE% VRNC60991T 9/4/2017 9/4/2018 E.L.DISEASE-EA EMPLOYE E 500 000
X9 myo Jw uMa
OESLRIPTION OF OPERATIONS EeIaw E.L DISEASE-POLICY LIMIT S 500,000
A COadercial Property 513535217 9/4/2017 9/4/2018 0-111111000
DESCWPTION OF OPERATORS LOCATIONS I VEHICLES MOORD 101,AEOMone RemeM NmSA ,may be a aechm M s— Rce Is Mum)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Evidence of Insurance THE EXPIRATION DATE THEREOF, NONCE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORED 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
INSO25 mmmn