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43-009 123 WESTHAMPTON RD BP-2019-0108 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:43 -009 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-2019-0108 Protect# JS-2019-000179 Esc CosC$3442.0 Fee, $65.00 PERMISSION IS HEREBY GRANTED TO: const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sp. H.)' 16683.48 Owner: DONNELLY MARINA&BRIAN zoning: Applicant.- AMERICAN INSTALLATIONS LLC AT. 123 WESTHAMPTON RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.713012018 0:00:00 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 Occupancy Signature: FeeTvpe: Date Paid: Amount: Building 7/30/20180:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use wiry City of Northampton Status Of Permit !jp Building Department Cuib CuNDdveway Pemdt 212 Main Street SewedSeptic Availability RDom 100 Wine rNVell'Avalablity.777777777-7 Northampton, MA 01060 TWo§etsofSWctuml'Plans 13-587-1240 Fax 413-587-1272 Ploteite Plans rfher:sIN _ pT OF noon+A CONSTRUCT,ALTER,REPAIR,,✓R/EN OVATE ORDEMOLISHAONE OR TWO FAMLLYDWEWNG SECTIONI -SITE INFORMATION 1.1 Property Atltlress: This section to becom ted by dmce Map FLol /1 17 O IL 123 Westhampton Road Zone Overlay Otstdet EIm at WstriG. WDistrict SECTION 2-PROPERTY OWNERSHIPIAUTHOR17ED AGENT 2.1 Owner of Record: Marina&Brian Donnelly 123 Westhampton Road Name(Piss) ComaNemng Address: (908) 462-2124 See attached Telephone Signature 22 Authorbad Agent American Installations 130 College St., .Ste 100 South Hadley,MA 01075 Name(Print Curent N mng Aidnies: 413-552-0200 Signer Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bpermit applicant 1. Building 3442.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Consbuclon from S 3. Plumbing Building Permit Fee // 4. Mechanical(HVAC) 7 0 5 S.Fire Protection S. Total= 1+2+3+4+51 3442.00Check Number This Section For Official Use Only Bu ding Permit Num6e Date Issued: -71 25v/263 SlgnaN Balding Co I.—Aapeolor of Buildings Date Section 4. ZONING All Inforowtion Must Be Completed.Pemdt Can Be Dented Due To Inromplete adormatlon Existing Proposed Required by Zoning This column to be filler m by HuBdiog Dapurmml Lot size FroD � Setbacks From O Side L:=R-= LR= L� Rear Building Height Bldg Square Footage Open space Footage % r-- D.0 un ndaubide&prved #offadding Spaces r Fill: Nato..&Laudao A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES Q IF YES,date issued) IF YES: Was the permit recorded at the Registry of Deeds? _ NO O DONT KNOW O ��YES Oj IF YES: enter BookL� Pag`L_—I and/or Document#F B. Does the site contain a brook,body of water or wetlands? NO O DONT KNOW O YES O IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O ,Date Issued: C. Do any signs exist on the property? YES O NO O IF YES,describe size,type and location: F- D. D. Are there any proposed changes to or additions of signs intended for the property 7 YES O NO O IF YES, describe size,type and location: E. WBI the constmlxion actiftdslurb(dearing,grading,excavation,orBNng)over i acre or is it pan of a gammon plan Mat wfll disturb over lam? YES O NO O IF YES,Men a Northampton Storm Water Management PermKfrom the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all awficablel New House ❑ AddRion ❑ Replacement Windows Alteration(-) El Roofmg El Or Doors E3 Accessory Bldg. ❑ Demolition ❑ New Signs QUI Deeks [o Slding[p1 OMer[A edef Description of Proposed Work: Attic and basement insulation and air sealing throughout Alteration oreActing bedroom_Yes_No Adding new bedroom Yes No iv Attached Narrate Renovating unfinished basement _Yes _No Plans Anached Rog -Sheet 5a.lf New house and or addHionto existing housing,complete thefoilowing: a. Use of building:One Family Two Famity Other b. Number of rooms M each family unit: Number of Bathm rns a Is there a garage attached? d. Proposed Square footage of new consimction. Dimensions e. Numberofsmdes? I. Method of headng7 Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masschedc Energy Compliance form agached? h. Type of construction 1. lsc strumiunwiMMIODfLofwegands?_Yes _No. IsconsWmlmwithin100yr. goodptatn Yes_No 1. Depth of basement or cellarOoor below finished grade k. Will bulling coMmn to the Building and Zoning regulators? Yes_No. I. SepOcTank CKy Sewer_ Pdvatewell_ Citymtw Suppty_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMR see attached ,as Owner of the subject Property herebyauthodze American Installations to est on my behalf,In all mailers rotative ta work aulhar'¢ed by this bdkgrg permit application. See attached Signature of Darter Data 712012018 1. American Installations .as Omw/Authudzed Agent hereby declare that the statements and Information on Na foregoing application am true and accurate,Mlle beat of my knowledge and belief. Signed under the pains and pen dies of perjury. American Installations Prim Name �,l eaeof Q,� V_. Cs ➢ n� 7/20/2018 SignsbdAgem Data SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Nam*of Usem*Notder- WesleyK. Couture 106178 Umosa Number 130 College St., Ste 100 South Hadley. MA 01075 9129119 Address Etpaeem bele CZXx!l i, 413-552-0200 31aneWe —�— Telephone Sl Registered Nome ImprovurneritC ntiacto T. Not Applcable ❑ Wesley Couture 175982 Company Name Registration Number American Installations �12fi119 Address EzptreBon Dale 130 College St., Ste 100 South Hadley, MA 01075 7elaphrre 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 titls affidavit will resuti In the denial of the issuance of the bolding permit. Signed AlBdevitAtteched Yes....... 0 No...... ❑ 11.'-Home Owner Exemption The uukrerrt exemption for'homcowners"was=#ended m imlude 0mmer-occupied Dw tones of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does net possess a licam e,provided thatthe owner acts as apoerviser CMR 780 Sfath FAtlen Section 108351 Definition of Homeowner,Pence(a)who own a parcel of land as.which hetshe resides or intends to resides on which there is,or is intended to be,a one or two family dwelling,attached or detached steel=accessory to such use Nidt or farm structures.A amenh constructs mom than one he=In a two-year riod ah R not be considered a ho eowu . Such"homeowner'shall submit to the Building Official,on a from,acceptable to the Building OlDcia4 that he/she shall be responsible for all such welt performed under the building permit As acting Construction Suomvtsoryompremnec,onthe 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(Workws'Compemation) and Chaptul53(ISabilityof6mployetsto Employees for injuries not resulting in Death)of theMaseachuseus General Iaws Annotated,you may be gable forpersou(s) you hire to Pude®work for you under this permit The undersigned"homeowner"certifies and assumes respomr%dq foreumphausee with the State Building Code,City of Northampton Ordinances,State and Local Zoning laws sed State of Massachusetts Genual Laws Amounted. see attached Homeowner Signature City of Northampton " Massachusetts l; s t: Tt04 i OEFERrffi9'Z OF EOZLOIm IESFECTZOaS �' p Z".. 212 Main 2G-- •nnlNn 0BW1Ainp aerGEupG , !a. 0101060 YJ� 123 Westhampton Road Property Address: Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley, MA Phone: 43-552-0200 Property OwnerMarina&Brian Donnelly Name: Address: 123 Westhampton Road City, State: Northampton,MA 01062 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 signature Date 7/20/2018 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. 1 Address of the work: 23 Westhampton Road The debris will be transported by: American Installations The debris will be received by: Waste Management of New England Building permit number: Name of Permit Applicant l es\a C ao Ev rt 7/20/2018 Date Signature of Permit Applicant 4^ mass save s®,,,ea mx,w PARTNER .va cu a:1astn ma a,�mwrwnnrssaz American Installations wrw'Amerionlmbllaeens.rom ae]W,si IgUp.MAOV)5=par-li s"..Ia,:Wal X2AID2,Fm,ik,uON,t@Pme,e,nMilaxaY"on,[mm Customer Name:Marina Donnelly Email:Not provided Phone:908-462-2124 Premise Address:123 Westhampton Rd,Northampton,MA 01062 Project 10:3426354 Date:July 1,2018 Job Description W6 xr,_r`�"4., 'x"L-, r {.?x ... iwea ,=;a.;}^: F. �.b Air Sealin.. at Estimated 62.5 GFM60 Per Hour 8 _ hr _ $740.64 KOO Door Sweep(with AS hrs) 3 each $75.93 _. $0.00 Exterior Door Weather Stripping (with AS his) 3 each $90.21 $0,00 Damming 102 each $243.78 Hatch -2"Thermal Barrier Pi each $46.28 $11.57 Propavent 63 each $262.08 $65.52 Rim Joist-6"Fibergtass Betting 76 SF $205.20 $51.30 Attic Floor-8"Open Blow Cellulose 840 SF $1,478.40 _ $369.60 Attic Floor-6" Dense Pack Cellulase 120 SF $298.80 $74.70 - - -� - Project Total $3,441.32 Weatherization incentive ($1,900.91) Air sealing Incentive ($906.78) Total Program Incentive -$2.807.69 Customer Total $633.63 wAawxty:a,iw,2,.immMam,,LLewixao.ia me,w.,,<,Leawm,w�w wima L.,,a,w,k„o,xnp.n„n.. 69Mem;LLC M,MwWow,M, * ..lil ll rrowriai,m i,eo,maomplAeLr.Mavr wOpe of wuLm,,,o,mrc,wm:Maeoveipe[xivCon,anall b„I arJftnw xe bn mala., roe mal w..crown �„m,m PCCEtt.,NCE OF AnFOY,t: ll'e ... I'i[es. VALUE= 635 63 .63 „uea,ra...a„ene.a.x,mL,e.r... awhonssemeow1 av sn.uinli 1,. 5 1 g0:00 nx Le Vs.aril—.A of—,aM eal.we me I c11i rPio Marina DonnellM, y �,.a" ntv1B Donnelly,Marina Mooub ow,..lvantl Tarn) o,w Craig A.Dragovich us”) ^�• The Commonwealth of Massachuaens Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 01111 www.massgov/Jia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letdbly Name mashassiorganim6nMndividudp: American Installations,LLC Address: 130 College Street,Suite 100 City/State/Zip: South Hadley,MA 01075 phone#: 413-552-0200 Are you an employer?Check the appropriate box: Type of project(required): I.❑ 1 am o employer with 46 — 4. E] I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or purmer- listed on the attached sheet.t 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9, ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.L] Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself.1No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.I employees. [No workers' 13.M Other Insulation red.] -- o 1 comp. insurance requi _ J *Any nppliont tWt checks box MI monism fill out d,sttliun blow showing dolt workers compensaun policy information. i InmeowneN who suhmil tM1is nffidovit imlicaline they ora doing all work and thushire maid,contractorsmust submit o new all buil i,Mkminy suet. :Conozetors dam chock this box must nmehml an addidonat short showing the name of the suhsummewrs and their workms'comp.policy inPormmiom. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site lafaUnation. Insurance Company Name: Guard Insurance Policy#or Self-ion. Licq.#: AMWC8973,8,,7y�r� Expiration Date: 0�9//04/200118�i., n �Ip Job Site Address: 12,3 I�P,S±hQ�I)Il)1 I R006 City/StmdZip,W hall4J lt� IHI1 a(U(fi2 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 fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ufup to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA far insurance coverage verification. t da herehy certify under the pains a/nd penalties ofperjury that rhe information provided above is true and correct. Sian— a2 him (t- l D V Min #: 413-55f0200 Official use only. Do not write in this area,to be completed by city or town offrciai City or Town: permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.Cityrrown Clerk 4. Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Commonwealro of Massachusetts Coru9ruclron Bupxvrvor ®� Division of Professional lkensure Umesbped-Buildings a any war group adicb ceream Board of Building Regulations and Standards less than 36.000 cubic fed(091 dGlc males)of enrdo!{d Construction Supervisor space. CS-106178 E;pires: 09M2019 - VVIESLEY0OUTURE 218 THR1vaTR SOUTH HADLETMA01M6 3 „' - .. +F FaNssIn possess a current wagon of the Masaaclraaefb State Building Code is cause for revocation oft is license. (�`g For Inliama Bon about Mis licence Commissioner v"� "1(017)7274209 Of vkn wwwmaugovidpl r ire ,,,,,tn,„�/���r Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type. LLC AMERICAN INSTALLATIONS,LLC. Regxpation: 175982 130 COLLEGE STREET SURE 100 ExExpiration: 08282019 SOUTH HADLEY,MA 01075 Update AdtlroN anti rNurn card klarkreascnforcAarge. SCA1 0 : MALtt Add.^^• ❑ny..._.1 ❑Empinyvmet 0 L9s1 Card offlaew consumer Ator.& uelnaas Repuletlon HOMEIMIMIOVEMEWCONTRACTOR RoglHMlon valid for Individual use only TYPE:LLC "fors Me expiration data If found Mum to: egg Expiration Office of Consumer Affairs and Business Regulation \ 175902 06/26/2019 19 Park Plaa-Suke 61M AMERICAN INSTALLATIONS,LLC. Boston,MA M116 WESLEYCOU130 COLLEGE STREET 12.frL�A--- SOUTH LEGE STREET SUITE 10) U r t valid without signature SOUTH HADLEV,MA 01075 Undersecretary 9 '{� CERTIFICATE OF LIABILITY INSURANCE D"TEIMwD 8/14/2017 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 INSUREIU$), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to HER terms and conditions of the policy,certain policies may require an endorsement A statement on this corticate do"not confer rights to the certificate holder In HER:of such endomement(s). PRODUCER SME:NTA T Linda Power. Webber 6 Grinnell PxoxE (4131586-0111 FNC Ho a<131586-6e8] 8 North Xing Street " kSsslpo3rera@webberendgrinnell.cm INSURE 3 AFFORDING COVERAGE XAICp Northampton DBL 01060 INSUREFEAsDePloyerS Mutual Casualty INSURED INSURERSBerkshire Hathmeaty GDARD Ins. Co. American Installations, LLC INSURERC: Attn: Nes 6 Susanne Couture INSURER D: 130 College Street, Suite 100 INSURER E: South Hadley HIL 0307$ 1 INSURER F: COVERAGES CERTIFICATE NUMBERHaster Axp 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. INBmR TYPE OF INSURANCE L U. POU"NUMBE0. POLICY EFF MPSEDICYEXP LIMBS COMMERCNLGENERALLIABIUTY EACH OCCURRENCE $ 1,000,000 A X CSAIMSIAAOE 1:1 OCCUR PREMISETO RIG I In S Ee aw $ 500,000 503535217 9/4/2017 9/4/2018 MED AXE(11,one 141 $ 10,000 PERSONAL B ADV INJURY $ 11000,000 GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 A POLICV�PRO LCC PRODIKTS-COMP,OPAGG S 2,000,000 ECT OTHER: $ AUTOM09ILE UABIUtt Ea ectiCenl L L $ 1,000,000 A ANY AUTO ROD I LY INJURY Pe PNMn) S ALL O0e ED X SCHEEDDULED 543535211 9/4/2017 9/4/2018 BODILY INJURY(Pergmaa,nl $ TOS NON—EO PROPERTY DAMAGE $ 'Z HIRED AUTOS y` AUTOS Per—dere PIP.EesC $ 8,000 A UMBREL1 UAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS UAB ELAINE MADE AGGREGATE $ 1,000,000 LEO I X I RETENTIONS 313,000 SI3E3S2.7 9/4/2011 9/4/2013 $ YORKERS COMPENSATOR PER TH- AND EMPLOYERS'LAW LITY X STATUTE ER ANY PROPRIETORPARTNEWEXECV➢VE YO NIA EL EACH ACCLEM $ 500,000 OFFICERMEMOER EXCLUDE% B (Meed. ,ln Nm xc 6099]] 9/4/2017 9/4/2018 E.L DISEASE.EA EMPLOYEE S 500,000 I aea<abe Nrem GE SCR IPTION OF OPERATIONS come EL DISEASEPOLICYLIMIT S 500,000 A Commercial Property SA3535217 9/4/2017 9/4/2018 aeauc .SlmO DESCRIPTION OF OPERATORS I LOCATIONS VEHICLES(ACORD 101,AaalBonal Remade SaneOUle.MEN be aNaCNM II more pace Is requlna) 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 REPRESENTATVE Kevin Joyce/LMP ©1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25)2014/01) The ACORD name and logo are registered marks of ACORD INS02512D,4Dn