25A-075 (12) 59 COOLIDGE AVE BP-2019-0245
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man-Block:25A-075 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-2019-0245
Proiem0 JS-2019-000393
Est Cost $3739.0
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grow, AMERICAN INSTALLATIONS LLC 106178
Lot Size(so. ft.): 5314.32 Owner: BRESNITZ VIVIAN
Zoning? URB(100)/ Applicant: AMERICAN INSTALLATIONS LLC
AT.- 59 COOLIDGE AVE
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:8/2412018 0.00:00
TO PERFORM THE FOLLOWING WORK.•WALL INSULATION
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 8/24/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
i T Department use orgy:
City of Northampton Status Of Perml'
.v ' Building Department Curb Gut/Ddveway Permit
212 Main Street Sewary$eptic-Avalleblli[y
�^ c Room 100 WeterlWell`Awflabolly,::.
m m Northampton, MA 01060 Two Sete oratnetuml Playa
413-587-1240 Fax 41&587-1272 PlaVs(e iPiens
OBrerSpedfy-
NSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION M_ t q ted'
1.1 PropeerW Address: Thle section to be eompbae�b"
ce
Map as Lot O� Unit.
59 Coolidge Avenue 1st&2nd floor
Zone Overlay District
Elm SL Dietrtct. CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Vivian Bresnitz 59 Coolidge Avenue 1st floor
Name(Pdm) Cunent McBng Address:
1413) 348-0412
See attached Telephone
Senate
22 Authorized Agent:
American Installations 130 College St., Ste 100 South Hadley, MA 01075
Name(Print) - Cvrent Mamng Add..
V- c ulj .. 413-552-0200
Signelura�l Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed In, ermit applicant
1. Building 3739.00 (a)guiding Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Penult Fee I
4. Mechanical(HVAC)
5.Fire Protection
8. Total= 1+2+3+4+5 3739.00 Check Number bs�
This Section For Official Use Onl
Bulldog Panna Date Number. Issued:
Signature: i
Building Commkefonemnspeolm of BuHdbVs Date
Section 4. ZONING Aft Information Must Be Completed.Permit Can Be period Due To Incomplete Informstbn
Existing Proposed Required by Zoning
Thisml.totemaiiuby
Idesdfvg C" amen
tan
Lot Size
Frontage
Setbacks
Side L:= R:= L:rrr--� R:�
Rea
Building Height
Bldg.Square Footage C� �� %
Open Space.Footage %
(I.otum nuvue bldg do Paved
u4iv
#of Parking Spares
Fill:
volume&.fuudm)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 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 Page= and/or Document#1
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:
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. Will the construction activity disturb(clearing,gradig, mavafion,orfilling)over 1 acre or is it pad of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Penult from the DPW Is required.
SECTION 5.DESCRIPTION OF PROPOSED WORK(check all applicable\
Nev,House ❑ Addition ❑ Replacement Wlndows Alteration(s) EDRoofing E]Or Doors ❑
Accessory Bldg. ❑ Demo
lRion ❑ New Signs [O] Decks [I- Siding(0] Other[
BdefD--dron of Proposed
Work: Wall insulation
Alteration ofexisttng bedmmn_Yss_No Adding new bedroom_Yes No
Attached Narmfwe Renovating unfinished basement _Yes No
Plans Attached Rog -Sheat
.. _
Its.If New house and or addition to ex]sting housing..comolte the following:
a. Use of buOding:One Famiy Twp Famfiy Other
b. Number of rooms in each family unit Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of sordes?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masschack Energy Compliance form attached?
h. Type of construction
1. Is construction within 100 fL of wagands?_Yes _No. is construction within 100 yr. floodplain____Yes____No
j. Depth of basement or eager floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes_No.
I. Septic Tank_ Chy Sewer_ Pdvatewell^ Clywater Suppy_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject
property
herebyauthortze American Installations
to act on my behalf,in all matters relative to work authorized by this building permit application.
See attached
Slgnawre ofOwner Date 8/18/2018
I, American Installations as wn
Oer/AUthmized
Agent hereby declare that the statements and Information on the foregoing application ars true and accurate,to the hast of my knawkdge
and belief.
Signed under the pains and penalties of perjury.
American Installations
Print Name V
4r,A r• A1L1f rnP Date 8
Signature of Agent m
SECTION 8-CONSTRUCTION SERVICES
8.1 Lleensed Construction Stme rvisoC Not Applicants ❑
Nareopf Ucerue Holder. We 8Y K. Couture 106178
Ucanes Number
130 College St., Ste 100 South Hadley, MA 01075 9129119
Addrresss " Expiration Dote
,SAAgNS�_ inn V- auLl 413-552-0200
Sipnalure Telephone
Registered
- _.. _
9 R1st retl-H m Improvement Cocto - _ -_ - Not Applicable ❑
Wesley Couture 175982
Company Name Registration Number
American Installations 6/26/19
Address F�piretion Date
130 College St., Ste 100 South Hadley, MA 01075 Telephone 413-552-0200
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152, 225C(5))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this eHWavit will result
In the denial of the Issuance of the bu8ding permit.
Signed AflidavitAttachad Yes....... 131 No...... ❑
11. -Home Ow=ner Exemption
The portentexemptionfor"bomeownt&'wasextendedto include Owner-occupied DweWm aofone(l) m two(2)families
and to allow such hovwonver to engage an individual for hire who does not possess a license,provided that the owner ach
as supervisor.CMR 750, SM Edition Section 1083 51.
Definition of Homeowner;Person(s)who own a parcel ofland on which he/she resides or intends to resid%on which there
is,or is imeadedto be,a one w two family dwelling,attached or detached structures accessory to such use and/or farm
struchrom.A person who constructs more than one home in a two-year period shall not be co sidared a homeowner.
Such"homeowne2'shall submit to the Building Official,on a form acceptable to the Building Official,thai sb#Ak
Wilemsible for U suct,work Perfamed Duda the bafidina peradt.
As actingCnnalrucdpn Supervisor yompreamce on thejob site will be required from time to time,during and upon
completion ofthe work for which this permit is issued
Also be advised that withreference to Chapter 152(Woekers'Cmapeosatiou) and Chapter 153(Liability ofEmployers to
Employees for injuries not resulting in Death)ofthe Massachusetts Gencml Laws Annotated,you maybe gable forperaon(s)
you hire to perform work for you under this permit
The undersigned"homeowner"certi5w and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State end Local Zoning Laws and State ofMasse chuseth General Laws Annotated.
Homeowner Signature
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 59 Coolidge Avenue 1st & 2nd floor
American Installations
The debris will be transported by:
The debris will be received by: Waste Management Of N. E
Building permit number:
Name of Permit Applicant Wesley Couture
8118/2018
�n� 12 rG1AQi�n o
Date Signature of Permit Applicant
City of Northampton
Massachusetts
d• s
osras6aoavr or sorao:ac zasp Inas
212 win eex t . Mnicipsl evilain,
NoitAwpton, in 01060
59 Coolidge Avenue 1st&2nd floor
Property Address:
Contractor
Name: American installations
Address: 130 College Street Ste, 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property Owner
Name: Vivian Rresnitz
Address: 59 Coolidge Avenue 1st&2nd floor
City, State: Northampton,MA 01060
I, American Installations (mntraator)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 q /��
`nA4 .tln l.hl LU IfU ,
Date 8/18/18
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, 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: 59 Coolidge Avenue 1st & 2nd floor
American Installations
The debris will be transported by:
The debris will be received by: Waste Management Of N. E
Building permit number:
Name of Permit Applicant Wesley Couture
8/18/2018 V.
Date Signature of Permit Applicant
• mass save
.cores maam PARTNER
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'""s`0`"'oipnv 1159 American Installations www-Amminnlnstallatlons.com
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Customer Name:Vivian Bresnitz
Email:Not provided
Phone:413-348-0412
Premise Address:59 Coolidge Ave, t.Northampton,MA 01060
Project to:3415826
Date:May 21,2018
Job Description
- ----
Rim Joist - 2"Thermal Barrier Polyiso 26 SF $124.28 $12.43
Exterior Perimeter-4" Dense Pack Cellulose 771 SF $1,904.37 $190.43
Project Total $2.028.65
Weatherization incentive ($1,825.79)
Total Program Incentive -$1,625.79
Customer Total $202.86
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THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIOE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTRE AGREEMENT BY THE PARTIES INVOLVED. THIS
AGREEMENT IS BETNEEN AMERICAN INSTALLATIONS,DEC HEREINAFTER REFERRED TO AS"COMPANY,AND THE CUSTOMERISI NAMED ON THE REVERSE SIDE,HEREINAFTER
REFERRED TO AS"CLIENT",AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT
RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS.
THE FOLLOWING TERMS AND CONDITIONS ALSO APPLY
1, THIS AGREEMENT IS SUBJECT TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THE AGREE VENT TO BE EFFECTIVE UNDER ANY CONDITION.
3. SHOULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM TH E DATE THEREOF AT A RATE OF ONE AND ONE-HALF h-1/]I
PERCENT PER MONTH,(18%PER ANNUM)WITH A MINIMUM CHARGE OF$2 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 PND BY THE CLIENT IN ADDITION,CLIEM UNDERSTANDS THAT IN FAILING
TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY HAVE THE RIGHT TO A LEIN ON THE PROPERTY.
3. THE COMPANY AGREES THAT WHEN DELAYS BECOME KNOWN TO THE COMPANY,THE COMPANY WI LL ADVISE TILE CLIENT AS SOON AS REASONABLE.
A. COMPANY AGREES THAT,NOTWITHSTANDING ANY AGREEMENT FOR MATERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY 15 RESPONSIBLE
TO CLIENT FOR COMPLETION OF ALL WORK DESCRIBED IN ATIMELY AND WORKMANLIKE MANNER.
5. ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SUPPUEU BY THE COMPANY UNDER TH15 AGREEMENT SHALL BE THOSE GIVEN By THE MANUFACTURERS OF SUCH
EQUIPMENT AND PRODUCTS. UNDER SUCH MANUFACTURER'S WARRANTIES,THE CLIENT MAY BE REQUIRED TO REGISTER OR MAIL IN A WARRANTY CARD OR OTHER
EVIDENCE OF OWNERSHIP AND USE OF SUCH EQUIPMENT ARMOR PRODUCTS IN ORDER TO ACTIVATE SUCH WARRANTIES.
6. THE QUOTATION ON THE PAGE HEREOF DOES NOT INCLUDE EXPENSES OR CHARGES FOR BOND OR INSURANCE PREMIUMS OR COPTS BEYOND NORMAL I NSURANCE
COVERAGE ANY SUCH ADDITIONAL EXPENSES,PREMIUMS OR COST SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT
]. THE COMPANYS LIABILITY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AGREEMENT PRICE EXCEPT TO THE EXTENT THOSE DAMAGES
ARE PROVEN TO BE SOLEY DUE TO THE COMPANY'S NEGLIGENCE.
8, DURING THE DURATION OF THE WORK,THE CLIENTS HEM EOWNERS INSURANCE WILL BE RESPONSIBLE FOR ANY AND ALL DAMAGES AS LONG AS THE COMPANY HAS
TAKEN THE APPROPRIATE ACTION TO PROTECT AREAS OF WORK.
9. THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICI ENCIES 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. IF A PREEXISTING DEFICIENCY
OR HAZARDOUS MATERIAL IS ENCOUNTERED PRIOR TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING,COMPANY WILL TRV TO ASSIST CLIENT
WITHIN THE COMPANY'S MEANS AND CAPABILITIES TO CORRECT THE PROBLEM(S)ON A TIME AND MATERIAL BASES CLIENT AGREES THAT SUCH CONDDIONS 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.
30, THE COMPANY IS NOT RESPONSIBLE,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS ANO/OR DAMAGES,INLCUDING BUT NOT
LIMITED TO MOM GROWTH,ARISING FROM THE PERFORMANCE OF AIR 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 AND/OR AFTER THE PERFORMANCE OF WORK BY THE COMPANY,
13. REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,ROOF JACKS,VENTILATORS,FLSNAG,METERS,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 HAIRLINE FRACTURES 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 COMPANY'S EXPENSE.
14. THE COMPANY UNDER PROVISIONS OF CHAPTER 142A OF THE GENERAL LAWS IS REQUIRED TO APPLY FOR AND OBTAIN ALL CONSTRUCTION-RELATED PERMITS. THE
COMPANY SHALL NOT BE DEEMED RESPONSIBLE FOR DELAYS IN THE WORK DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR
INSPECTIONAL AGENCIES,AUTHORITIES,OR INDIVIDUALS.
15. THIS AGREEMENT,INCLUDING THE PROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE,CANNOT BE C HANGED OR ALTERED EXCEPT BY A WRITTENSTATEMENT
SIGNED BY BOTH THE COMPANY AND THE CLIENT.
16. ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY
EITHER PARTY,AND DO NOT SURVIVE THE EXECUTION OF THIS AGREEMENT.
17. THIS AGREEM ENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN.
18. THIS AGREEMENT,AND ANY WARRANTY(S)PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY OR WITH THE WR17EN PERMISSION OF THE COMPANY.
19. IF THE CLIENT FAILS TO PERFORM ITS OBLIGATIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE
CLIENT SHALL BE LIABLE FOR DAMAGES FOR THE GREATER OF THE COMPANY'S ACTUAL DAMAGES OR 25%OF THE AGREEMENT FOR RESTOCKING FEE.
10. ANY CHANGES TO MATERIALS BY THE CLIENT(BRAND,STYLE,COLOR,ETC.)AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT
IN A 5%RE STOCKING FEE BASED ON THE COST OF SAID MATERIALS.
]l. THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH LIME 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 15 NOT EARLIER EXECUTED BY THE HENT AND THE
REQUIRED DOWN PAYMENT RECEIVED PRIOR TO THE EXPIRATION OF SUCH 90 DAV FE ROD,AFTER 90 DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE
PROPOSAL.COMPANY RESERVES THE RIGHT TO REVISE 16 PRICE IN ACCORDANCE WITH ITS COSTS IN EFFECT AT SUCH TIME,
3L IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABIE,THE VALIDITY AND ENFORCEBILITY OF THE REMAIN ING PROWSIONS OF
THIS AGREEMENT SHALL NOT BE AFFECTED THEREBY.
33, ARBITRATION:IN THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE FORMS,CONDITIONS,PROVISIONS,OR PERFORMANCE OF THIS
AGREEMENT,THE PARTIES AGREE TO PLACE THE MATTER IMO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION
ASSOCIATION TO RESOLVE THEIR DISPUTE,
Z<, ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM(IF MA5SSAVE")ESUBIECTTOTHE
AVAILABILITY OF QUALIFYING STATE SPONSORED PROGRAM AND WILL BE SUBJECTED TERMINATION IF TIE STATE SPONSERED UTILITY PROGRAM IS DISCOUNTINUED.
FURTHERMORE,THE TERMS AND CONDITIONS OF STATE SPONSERED UTILITY PROGRAMS MAYBE ALTERED ON UPDATED PERIODICALLY WITH OR WITHOUT NOTICE.
25. AMERICAN INSTALLERS,LLC IS NOT AN AGENT OF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE'ENERGY
PROGRAM.
26. HENT IS REPSONSIBLE FOR THE PAYMENT OF ANY AND ALL FEDERAL,STATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AGREEMENT.
Affil www Amenonlmtalhtan.runt
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American Inatallatlona MAREAra 11-1 75982
130rnw..San,got.1.x.ew Maours.ghe:"gal Mo.FAR:1.131 sstGaEo Em.Ik ex4peneAlxerlOnmma.xonrsam
'1 nevsky&Morally Maya&Erin 11/10/2017
59 Coolidge Avenue 2nd Floor Northampton MA 01060
(413)348-0412 rzm vannapnolDyahoo.rom
454494 F., 17-30518
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Guantity Unit Unk Cost Total
All 54alin(
Air Seal'mg $ -
AirSealinglncentive $
Air Selaing W%Balance $ -
Wertherimation
WALLS-VINYL SIDED a"CELLULOSE 877 1 drift $ 1.95 $ 1,710.15
Total Weatherization 5 1,710.15
Weatherization Incentive $ 1,539.14
Total Project $ 1,710.15
Total Utility Contribution $ 1,539.14
Total Customer Contribution $ 171.01
WAR Rann. -1111 nanllxi"n e.LLC NllpmvNe rxe aMe urM h—...wxn a 24nr Ev R-rupw,,r,nw
LLCRw1Ry,vdAWtRfEm1Eh,1I mnerOl a"eYmrmmmplerttxeabrceeopeolworLln raoremawxnmeabeupeeRexbmana tlllaalaM nne Wlle:ng
r
EPTANCE OF paoppdu xe....e or=e:epeMxi
s . ons and TOTAL CONTRACTVALUE= $ 171.02
poMhbns ere artisfittory 1.N art mrtMaeaptM.Y
amnomee meeworw assp.amw.p.ymem wwml/a eeero prbno Down Payment= $ 57.00 ❑
eWtelwork N Iwhnce ew upon Wnpletlmuo
Balance Due Upon Completion= $ 114.02 v
Vivian Bre4nit7 5-22-18
Barry/.tamer $ ..rw.r. 5-22-18
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THIS AGREE MEW IS COM POSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENT RE AGREEMENT By ME PARTIES I NVOCVED.THISAGREEMENT IS
BETWEEN AMERICAN INSTALLATION&LLC HEREINAFTER REFERRED TO AS'COMPANY',AND THE COSTOMER(S)NAMED ON THE REVERSE SIDE,HEREINAFTER REFERREDTO AS"Q.El'ANO
WILL BE SOBIECTT0 ALL A P PROPRNTE LAWS,REGULATIONS AND OR DINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WE LAS ALL L0CALIURISOICTI0NS.
THE FOLLOWING TERMS AND CONDITIONS AISOAPPLY
1.THIS AGREEMENT IS SUBJECT TO THE APPROVAL OF A MANAGER OF ME COMPANY FOR THIS AGREE MEW TO BE EFFECTIVE UNDER ANY CON OIP ON,
d.SHOULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF ATA RATE OF ONE AND ONE�HGLF(I 1/2)PERCENT PER MOWN.
INA PER ANNUM(WITH A MINIMUM CHARGE OF$1,OB PER MONTH,AND IF PLACED IN THE HANDS OF AN ATTORNEY OR COLLECTION AGENCY FOR COLLECTION,ALL ATTORNEYS'FEES,
EXPENSES AND COSTS OF COLLECTION SHALL BE PAID BY THE CLIENT IN ADDITION,CLIENT UNDERSTANDS THAT IN FAILING TO PAY ACCORDING TO ME ABOVE TERMS,COMPANY MAY
HAVE THE RIGHT TO A LEIN ON THE PROPERTY.
3,THE COMPANY AGREES THAT WHEN DELAYS BECOME KNOWN TO ME COMPANY,THE COMPANY WILL ADVISE THE CLIENT AS SOON AS REASONABLE.
A,COMPANY AGREES THAT, NORVITHECTODING ANY AGREEMENT FOR MATERIALS AND/00.LABOR BETWEEN COMPANY AND THIRD PAM,COMPANY IS RESPONSIBLE TO CLIENT FOR
COMPLETION OF ALL WORK DESCRIBED IN ATIMELY AND WORKMANLIKE MANNER.
5.ALL WARRANTIES FOR EQUIPMENT AND PRWUCT55UPPLIEO BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS OF SUCH ECUIPM ENT AND
PRODUCTS,UNDER SUCH MANUFACTURER'S WARRANTIES,TIE CLIENT MAY BE REQUIRED TO REGISTER OR MAIL IN A WARRANTY CARD OR OWER EVIDENCE OF OWNERSHIP AND USE OF
SUCH EQUIPMENT AND/OR PRODUCTS IN ORDER TO ACTIVATE SUCH WARRANTIES.
6.THE QUOTATION ON THE PAGE HEREOF DOES NOT INCLUDE EXPENSES OR CHARGES FOR BOND OR INSURANCE PREMIUMS OR COSTS BEYOND NORMAL INSURANCE COVERAGE ANY SUCH
ADDITIONAL EXPENSES,PREMIUMS 0R COST SHALL BE ADDED TO THE T0TAL AGREEMENT AMOUNT.
).THE COMPANHS 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
SOUPY DUE TO THE COMPANY'S NEGLIGENCE.
B.DURING TIE DURATION OF THE WORK,THE CLIENT'S HOMEOWNERS INSURANCE WILL BE RESPONSIBLE FW ANY AND ALL DAMAGES AS LONG AS THE COMPANY HAS TAKEN THE
APPROPRIATE ACTION TO PROTECTARFIS OF WORK.
THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS EG,W000 ROT,
MOLD,ASBESTOS,NAIL POPS,DUCTWORK AND CONNECTIONS,PLUMBING AND VENT PIPES,DECKING UEFLERAN ETC,IF A PRE EXISTING DEFICIENCY OR HAURCLUS MATERIAL IS
ENCOUNTERED PRIORTO OR DURING CONSTRUCTION,AND COMPANY 15 NOTIFIED IN WRITING,COMPANY WILL TRY TO ASSISTCLIENT WITHIN THE COMPANY'S MEANS AND CAPABIUTIES
TO CORRECT THE PR0BLEM(5)ON A TIME AND MATERIAL BASIS.CLIENT AGREES MAT SUCH CONDEgNS ARE UNAVOIDABLE 0Y THE COMPANY AND SHALL NOT BE CONSIDERED A
VIOLATION OF THE AGREEMENT AND THAT DUE TO THESE CONOTIONS THE DURATION OF THE WORK AND SCHEDULED DATE OF COMPLETION MAY DIFFER FROM THAI AGREED UPON,IF
APPLKABLEUNDER THIS AGREEMENT.
30,THE COMPANY IS NOT RESPONSIBLE,AND THE CLIENT AGREES TO HOLO THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES,INLCUDING BUT NOT LIMITED TO MOLD
GROWTH,ARISING FROM ME PERFORMANCE DEAR SEALING WORK BYTHE COMPANYASA RESULT OF ANY KNOWN OR UNKNOWN MOISTURE CONDITIONS.
Il.THE COMPANY IS NOT RESPONSIBLE FOR,AND THE CLIENT AGREES i0 HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS ANO/OR DAMAGES RELATED TO ICE DAMMING THAT MAY
ARISE DURING AND/ORAPE RTHE PERFORMANCE OF WORK BYTHE COMPANY,
IZ.REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,ROOF JACKS,VEMILATORS,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 DOMING OF INTERIOR WALLS AND CEILINGS, FLOORS TRIM,GUTTERS, DOWNSPOUTS EXISTING SIDING ANO
WINDOWS,DOORS,OIC DROPLETS IN DRIVEWAYS,HAIRUNE FRACNRES IN CONCRETE OR BLACKTOP DRIVES AND WALKS,OR OAMAGETO PLANTS OR SHRUBBERY.IF EXCESSIVE DAMAGE IS
CAUSED BY COMPANY,COMPANY WILL REPAIROR REPLACE DAMAGEOARM ONLYATCOMPANY'S EXPENSE.
]A.THE COMPANY UNDER PROVISION$OF CHAPTER SQA OF THE GENERAL LAWS IS REQUIRED TO APPLY FOR AND OBTAIN ALL CONSTRUCTIONAHATED 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 PRICEAND PAYMENT SCHEDULE,CANNOT BE CHANGED ORALTEREO EXCEPT BY A WRITTEN AATEMEM SIGNED BY RUTH THE
COMPANY ANDTHE CLIENT.
16.ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIALANO NOT RELIED ON BY EITHER PARTY,AND 00
N0T5URVIVETHE EXECUTION OFTHIS AGREEMENT.
V.THIS AGREEMENT CANNOT OECANCELI£D WITHOUT THE MMUAL WRITEN CONSENTOF BOTH PARTES FXCEPTAS OTHERWISE$ET F0RM HEREIN.
IS THIS AGREEMENT,ANDANY WARRENCLOS(PROVIDED HEREUNDER SHALL NOTES ASSIGNEDEXCEPT BY OR WITH THE WRITTEN PERMISSION OF ME COMPANY.
19,IF THE CLIENT FAITS TO PERFORM ITS OBLIGATIONS HEREUNDER OR TERMIN OE S THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT SHALL 0E
LIABLE FOR DAMAGES FORME GREATER OF THE COMPANHS ACTUAL UAMAGESOR 25%OFME AGREEMENTFOR RESTOCKING FEE.
30.ANY CHANGES TO MATERIALS BY ME CLIENT(BRAND.STYLE,COLOR ETC.)AFTER SAID MATERIAL HAS BEEN OELIVEREDOR IS IN PCOTETOTHE CLIENT COULD RESULT IN A 5%RE STOCKING
FEE BASED ON ME COSTOF SND MATERIALS.
Zl.THIS AGREEMENTSHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL.THE COMPANY RESERVES THE RIGHT
TO REVOKE THIS PR0POSAL90 DAYS FROM DATE IT IS MOLTEO BYTHE COMPANY IF IT IS NOT EARLIER EXECUTED BY THE CLIENT ANDTHE REQUIRED DOWN PAYMENT RECEIVED PRORTO
THE EXPIRATION OF SUCH 90 DO PERIOD,AFTER 90 DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE PROPOSAL,COMPANY RESERVES THE RIGHT TO REVISE IR PRICE IN
ACCORDANCE WITH IRCMTS IN EFFECT ATSUCH TIME.
ZZ.IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR ONENFORDABLE,THE VALIDITY AND ENFORCEPUPPY OF THE REMAINING PROVISIONS OF THIS AGREEMENT
SHALL NOT BE AFFECTED THEREBY.
23,ARBITRATION'.IN THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS,CONDITIONS,PROVISIONS OR PERFORMANCE OF HIS AGREEMENT,THE FAMES
AGREE TO PLACE THE MATTER IMO ARBITRATION BEFORE AN INDEPENOENT ARBITRAT0R ASSIGNED BY ME AMERICAN ARBITRATION WOCIATION TO RESOLVE THEIR DISPUTE.
ZA,ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OFA STATE SPgJSERED UTILITY PRW RAM(I E.MASS MSE-1 IS SUOJEQ iO THE AVAILAREM,OF
QOAUFQNG STATE SPONSEREO PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STAR SPONSORED OTBOY PROGRAM I$DISCOUNTNOEO.FURTHERMORE,THE TERMS AND
CONDITIONS OF STATE SPONSORED UTILITY PROGRAMS MAY BE ALTEREDOR UPDATED PERIODICALLY WITH OR WDHOUTNOTICE.
35.AMERICAN INSTALLERS,LLC IS NOT AN AGENT OF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE'ENERGY PROGRAM.
36,CLIENT M REPSONSIOLE FOR THE PAYMENT OF ANY AND ALL FEDERAL,STATE,OR LOCAL TAKES THAT ARE APPLICABLE TO THIS AGREEMENT.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
wi 600 Washington Street
Boston,MA 01111
www.mossgov/dia
Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leribly
Name(Rusimss/organimtion/Individuap: 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)
l.0 I am a employer with 46 _ 4. ❑ I am a general contractor and 1 6. ❑ New construction
employees(full and/or part-time).- have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for mein any capacity. workers'comp. insurance. 9, E] Building addition
(No workers'comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs cer additions
myself (No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance requiredl t employees. [No workers' —�
u.[]cher Insulation
camp. insurance required.) --� - ---
*Any applicant that checks box al mal also fill out the section below showing thxa wmkencompensation policy infomm...a,
t I Anneoweeem who vabmitIn,,affidi vii indicating they ore dum,all work aM an.him amenia cmtradors moat submit anew aliitlavit intlicating snit.
:Cummomo Nat dwvk this box mml mmched an nddiannel shat dwwing the name or rhe subeomru.tma and their workers comp.pir,information.
1 am an employer that is providing workers'compens'adon ineurancefor my employees. Below is the policy and job site
information
Insurance Company Name: Guard Insurance Companies
Policy d or Self-ins�Lie,(b: AM nW,C8y9�7387 _ Expiration Date: 09/04/2018
Job Site Address: �COb��aW Q. , ISI 321 LIT 1 City/State/Zip:N�Iv/111 O�tJ Iry
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 imprimnman:,as well ae civil penalties in the fr,rm of a S"FOP WORK ORDER and a fine
of up to$250.00 a day against the violator, Be advised that a copy of this statement may be Iorwarded to the Office of
Investigations ofthe DIA for insurance coverage verification.
1 do hereby ceeyt(y nastier thepaaiijns and prnal/ties of penury that the information provided aba a is true and correct.
S��w.erlp tXA kL �.f�LrT ¢. _-_Dole; _
Phone q: 413-55 -0200
Offlcial use only. Do not write In this area,to be completed by city or town off7cial.
City or Town: Permit/License a
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.Cityrrown Clerk 4. Electrical Inspector 5. Plumbing Impactor
6.Other
Contact Person: Phone g:
A`��® CERTIFICATE OF LIABILITY INSURANCE 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 INSURERIS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cent icate hold,]is an ADDITIONAL INSURED,the policy(hes)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endosement. A statement on this certificate does not confer rights to the
Caruthers holder in lieu Of such endosement(s).
PRODUCER NOME:CONTACT Linda POxere
WebbAC No.
er 6 Grinnell NONE )413)586-0111 FAX .( 3)S6-6
41e481
B North sting Street FUURIL $;lpoxera@webberandgrinnell.com
IXSVRE S AFFOROINGCOVERIGE NAlcp
Northampton MA 01060 INSURERA Em rs Huru 81CaaValty
INSURED INSURERo$ rkahire Hathawa GUARD Ins. Co.
American Installations, LLC INSURER C:
Attn: Was 6 Susanne Couture INSURER O:
130 College Street, Suite 100 INSURER E'.
South Hadley NA 01075 1 INSURER F:
COVERAGES CERTIFICATE NUMBERSfastr, Exp 9-2018 REVISIONNUMBER:
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.
ILTR PPEOFDSURANCE MLI YXUMMRMWLDICY EFF PµLpYEKP LIMITS
COMMERCML GENERAL UABILnY EACH OCCURRENCE S 1,000,000
AR CWMS'MA. [:1..NR PREMJE.oeou,Lr.l E 500,000
5n3535217 9/i/201] 9/d/2018 MED UP(My one pe,wn) S 10,000
PERSONAL&AM INJURY y 11000,000
GENT AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE 8 2,000,000
R PRD
POLICY JECT E LOC pR000Ci$-COMPAP AGG $ 2,000,000
OTHER E
AUTOMOBILE LIABILITY Eea COMBINED11
LIMIT E 11000,000
L .
A ANY AUTO BODILY INJURY(Per pe,wn) $
ALL OVMEDR SCHEDULED 523535y] 9/4/2017 9/4/2018 BODILY INJURY Perood nl) S
AUTOS AUTOS
q NON 'NUED PROPERTY DAMAGE
HIREDALIDS R AUTOS por CGae,ry E
PIRBesp S 8,000
R LALIA
UMBRELB OCCUR FALX IX:CURPENCE $ 1 000,000
A EXCESS UAB CIA MSMACf AGGREGATE S 1 000 000
DED y` i RETENTION 10,000 503535217 9/4/2017 9/4/2018 y
WORKERS COMPENSATION TH-
AND EMPLOYERS'LIABILITY YIN TATUTE ER
ANY PROPRIETORIPARMEWEoCCUTrvE EL.FACH ACCIDENT E 500 000
B OFFICERMEMBER EXCLUDED? F NIA
IMIMenaeWIN In IN) VaNC609917 9/4/2017 9/4/2018 EL-0ISEASE-EA EMPLOYE E 500 000
aexee9 uNer
DESCRIPTION OF OFERATIONSWee EL.DISEASE-POLDYLIMIT y 500 000
A CCore ercial Property 5A353521'I 9/4/2017 9/4/2018 aMudele El WJ
DESCRIPTION OF OPEW nONS I LOCAMNSI VEHICLES IACOR0101,AaaMonal RemeMe YIMNa,IT,be emceed N Mo.space N rpWrea)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
EVid.nCe Of In.cranCe THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNORQED REPRESENTATIVE
Kevin Joyce/LMP � -
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(201,V01) The ACORD name and logo are registered marks of ACORD
INSO26Pm1mn