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30B-119 (2) 63 WARD AVE BP-2019-0244 GIS#: COMMONWEALTH OF MASSACHUSETTS Map.Block:30B- 119 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-2019-0244 Proiect0 JS-2019-000392 Est Cost:$8192.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor. License: Use Groum, AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. ft): 18295.20 Owner: SCHOENFELD ELIZABETH Zoning URA(96)/WP(90)/RR(18)/FFR(0)/ Applicant: AMERICAN INSTALLATIONS LLC AT.• 63 WARD AVE Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMAD1075 ISSUED ON.8/24120180:00:00 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 OccuoancV Signature: FeeTvoe: Date Paid: Amount: Building 8/24/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only m City of Northampton Status of Permit �o s Building Department cum ewrnrvewey Parma C /m 212 Main Street Sewer/3ep8cAvalle¢Ally... Room 100 WaterAvewAvallabNgr _ Northampton, MA 01060 Two Sete of Saw$aal Pians ne 413-587-1240 Fax 413-587-1272 ploVSltePlans , z �' APPLICA CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DIVELUNG ON ECTION i-SITE INEOMATION 6 Q— f ct -a-4 Y 1.1 Proeerly Address: Title section to be completed by mi. Map �� Lot r r 9 Unit. 63 Ward Avenue Zone Overlay District Elm SL lest idt. CB Dismet SECTION 2-PROPERTY OWNERSHIPIAUTHORRED AGENT 2.t neo E)izabet Sc oenfeld&Pranay Parikh 63 Ward Avenue Northampton, MA 01060 Name(PdnD CuMMedi Address: (401)95-9296 See attached Telephone Signature 2.2 Authorized Agent; American Installations 130 College St., Ste 100 South Hadley,MA 01075 Name(Print) Carer Malting Address: .ve art ached A Aly r tL. i(n.t J 413-552-0200 Slgnepse Telaphorro SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be official Use Only completed by permitapplicant 1. Building 8192.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 3. Plumbing Building Permit Fee ,1 i 4. Mechanical(HVAC) Yf' 5.Fre Protection B. Total= 1 +2+3+4+5 8192,00 Check Number 166 This Section For Official Use Only Date Building Permit Number. leaued: r] Signature: Bowing Comminbnmllnvi mtor of Swirirgs Date Section 4. ZONING All Information?Bunt Be comptated.Permit cam Be Derded Due To incomplete information Existing Proposed Required by Zoning Tbia colmmmbefiBW hby r—^—� r—^ rrBngdiogDryatmml Lot Size Frontage setbacks Front 0 C] Side L:=R:= Rear i—( Building Height Bldg.Square Footage % Open space Footage (Ga acx minas trldga Puved � U LTJ L_J #of Paiking Spaces Fill: volume&.l.owdov I: A. Has a Special Permit/VariancefFincift ever been issued for/on the site? NO O DONT KNOW Q YES Q IF YES,date lssued:- --I if YES: Was the permit recorded at the Registry of Deeds? NO O DONTKNOW O YES O IF YES: enter BookL�J PageL---j and/or Document#) 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 he obtained from the Conservation Commission? Needs to be obtained O Obtained 0 ,Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: F 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. W0 the construction activity disturb(deadng,grading,issawagon,or filing)over i acre or is N part of a common pian that will disturb over t acre? YES O NO O IF YES,than a Northampton Storm Water Management Permgfrom the DPN!is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all enolieablel Naw House ❑ 1 Addition ❑ Replocementwindows ration(s) E] Roofing F1ar Doors O Accessory Bldg. ❑ Demogdon ❑ New Siam JE31 Decks 9=1 Slding[01 Omer ld'A Brief Description of Proposed Work Attic and basement insulation and air sealing throughout Aller"on of existing bedroom____ Yes_No Adding new bedroom Yes No Attached Namothe Renuvming unfinished basement Yes _No Plans Aaeched Rog -Sheet Ba.lf New house and-or addition to existinR'housina..comolate the following: a. Use of building:One Famgy Two Family Omer b. Number of rooms in each family unih Number of Bathrooms a Is mere a garage attached? it. Proposed Square footage of new,construction. Dimensions e. Number of stories? I. Method of heading? Fireplaces or Woedstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? K Type ofconstroubon 1. IsconstrucgonwMn100D.ofwegends?_Yes —No. IsconsWctionwilhint00yr. floodplain Yea_No J. Depth of basement or cellar Horn below finished grade k Wilt building conform to the Bidding and Zoning regulations? Yes_No. I SepflcTw*_ Cky Sewer_ Pdvmeweg_ GtywaterSupply_ SECTION To-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMPr I, as Omer of fhe subject property herebysuarodzenstallations to act on my behalf,in ail metlere We* b work authorized by this building permit application. See attached SgnaturecfOwner Date 8/18/201 I, American Installations as Omer/AAugwrtzed Agent hereby declare mal the statements and information on the foregoing appl teflon are true and accurate,tome best of my knowledge and ballet. Signed underthe pages and penalties of perjury. American Installations Prim Name \ h)tap„ V. ca �, 8/18/2018 Signature of WmarLyenl Data SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Suoervkor. Not Applicable d Namaaf Weanse Holder, Wesley K. Couture 106178 Uea,o;a Number 130 College St,Ste 100 South Hadley, MA 01075 9/29/19 Address E*Mftn Date 413-552-0200 Signalum Telephone e.keoistemd Home lmorovemeni toniiactorf . _ . . Not Applicable ❑ Wesley Couture 175982 Company Name Registration Number American lnstallalions 6,26/19 Address Expiration Date 130 College SL, Ste 100 South Hadley, MA 01075 Telephone 413-552-0200 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L,c,182,§28C(8)) 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 building permit. Signed Affidavit Attached Yes......, kl No...... O 11. -Rome Owner Exemption The current emmption for"homeowners"was extended to include Ownar-occuoiedDeremoas of one(1) or two(2)families and to allow such homeowner m engage an individual for hire who does not possess a license,provided thatthe owner acts ssswuervlser.CMR780. Sixth Edition Sm"1083.5.1. Oeffnition of Homeowner:Person(s)who own sparest of land on which be/she resides m intends to reside,on whichtheme is,or is intended to be,a one or two family dwelling,attached a detached structures accessory to sunt,use and or few structures.Anerson who constructs more than one ham in a twavw period shag not be considered a h meowne . Such"homeowner'shall submit to the Building Official,on a form acceptable to the Building OS,eia4 thathdaheahaU be resimaidble for aD anth workoerformed madw the boldin vermit. As acting Constrvetion Supervisor you presence on the job site will be required from time in timq during and upon completion of the work for which this permit is issued. Also be advised that with refaranoeto Chapter 152(Workers'Compamailon) and Chapter 153(Liability ofEmpioyers to Employees for injuries not resulting in Death)of the Massachusetts Gencral Laws Annotated,you maybe liable forpersoa(s) you hire to perform wak for you under this permit The undersigned"homeowner"certifies and assumes mpombilny for compha scemth the State Sodding Code,City of Northampton Ordinances,State and Local Zomng Laws and State ofMassachuaetls General Lava Annmmed. we attached Homeowner Srgnatae 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. 63 Ward Avenue Address of the work: American Installations The debris will be transported by: The debris will be received by: Waste Management of N.E Building permit number: Wesley Couture Name of Permit Applicant 8/18/2018 X\� Date Signature of Permit Applicant wAmennnlnsxallaGonimm IIS 1� • tow Licensed& ured MAM"1Min AtnirlCon lnatellatlons MA ae9ixxmnnn 41l59e1 e Hr n tte lOD SaulM1 lYdkY MAa10)5•OMn:nll)SR.YSW Fav lan155201aE•Email:wpponlAm✓IeelnnlNnom+am Schoenfeld&Parikh,ENzaheth&Pranay, B/9/2D]8 63 Ward AveNorthhampcon MA7. 01060 1-1 17. 14131822-]960 ax elizschoen@gmail.com a 470326 (rW nen 18-239] I=•.o� quantity Unit Unit Cost mn Total Nr 6ea8ng 0.WSEALING SO Imam houa $ 85.00 $ 850.00 WEATHERSTRIP DOOR&ADD SWEEP 5 each $ 80.00 $ 400.00 Air Sealing $ 1,250.00 Air Sealing Incentive $ (1,020.00) Air Selamg W%Balance $ 230.00 Weatherhatlon BASEMENT SILLS-R19 FG BATT 120 sgft $ 1.95 $ 234.00 ATTIC FLAT-r OPEN R-30 CELLULOSE SW igft $ 1.44 $ 1,352.W VENTILATION CHUTES 117 each $ 250 $ 292.50 ATTIC DAMMING-R-38 FIBERGLASS 113 sgft $ 2.05 $ 231.65 INSULATED BATH EXHAUST NOSE 1 each $ 60.00 $ 60.0 ATTIC HATCH-SEAL&INSULATE 1 each $ 60.00 $ 60.00 4"x IV SOSOFFIT VENTS 13 each $ 25.00 $ 325.00 WALLS-WOOD-51DED 4"CELLULOSE 2,352 sqh $ 1.95 $ 4,586,40 Air Sealing WX Balance I lumpsum $ MEG $ 230.00 Total Weatherization $ ],1]155 Weatherization lncentiye $ 6,454.40 Total Project $ 8,191.55 Total Utility Contribution $ 2,474.0 Total Customer Contribution $ 711.16 wnkux,w.Amenrae �mm�wox,u<wxi p,tom.me.hro.nn.amm.m....,am.lva.nokma..hio..,n.q. •umue..,u<n.,.rr w=pn•x ro wn un all mau,al..tl mm.w tom pin.m+.hw.,roto m.nn m acnrc..n.xn�n.aeo.e.pemmaloo..oe an lwl.,,e mn hupLAna MMaUensrerlM ieolbntrett Nlue armtetl M1enin. ACFPprAWE OF PFOF Ab.me au—phcea,xpmlft-t rand TOTAL CONTRACT VALUE= $ 712.16 rondttioos are vtisM1cmryandarc hzrcbvaaep4d. vovarc eyxhoneetlto do work rsahedned.paymmlwln be f/f down glor Down Payment= $ 2W.00 El 89.1b xn ixarx olwork,antl Wlanxe 4ue uryn UmplNbn. pAlp BalanceDue Upon Completion= $ 517.16 5•�rfeId& - h,Efiroem&pan, BA-]e � Isa m• ^p ns.Bhalan f— -oa rc 8/9/2018 sxrseemsou wnrvn uu r,eapw[eln weonow,raau wxrercw♦nrtvu✓,uweu uu�ouisneanve. x5,nvau.wnarooeunw¢sam[mm�rusuwwnxae PHIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE$I DE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN MSTALLATIONS,LIC HERONAREP REFERRED TOAS"COMPANY",EMPTIES CUSTOMERS)LONDON THE REVERSE SLOE,HEREINAFTER REFERRED TOM"CLIENT",AND WILL BE SUSPECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL MALL LOCAL JURISDICTIONS. THE FOLLOWING TERMS AND CONDITIONS ALSO APPLY I.THIS AGREEMENT RSUREST TO THE APPROVAL OFA MANAGER OF THE COMPANY FOA TNR AGREEMENT TO BE EFFECTIVE UNDER ANY CONOU FEW. 2.SHOULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGPEEMENT,CHARGES SHALL BE ADO ED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE.HALF(1-1/21 PERCENT PER MONTH.(19%PER ANNUMI WITH A MINIMUM CHARGE OF $3 M 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.(TIENT UNDERSTAND,THAT IN FADUNG TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY HAW I €RIGHT TO A LEON ON THE PROPER I Y. 1.THE COMPANY AGREES THAT WHEN DELAYS BECOME KNOWN TO THE COMPANY,THE COMPANY WILL ADVISE THE CGE NO M SOON AS RES.WNABG 4,COMPANY AGREES THAT,NOTWITHSTANDING ANY AGREEMENT RM MATERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,GOMPAtN IS R£SECONLE E TO CLIENT FOR COMPLETION OF ALI.WORK DESCRIBED IN A TIMELY AND WORKMANLIKE MANNER. S.ALL WARRANTIES POOR EQUIPMENT AND PRODUCTS SUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY T4E MANUFACTURERS OF SUCH EQUIPMENT AND PRODUCTS. UNDER SUCH MANUFACTURL WARRANTIES,THE CLIENT MAN BE ELDER£D TO REGISTER OR MAIL IN A WARRANT' CARD OR OTHER 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 CH4A6ES FOR BOND 0.2 INSURANCE PREMIUMS OR CASTS NETOND NORMAL I.YSURANCE COVERAGE,ANY SUCH AD 71MAL EXPENSES,PREMIUMS QR COST SHALL BE ADDEDTO THE TOTAL AGREEMENT AMOUNT. J.THE COMPANY'S LIABILITY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTS AGREEMENT PRICE EXCEPTTO THE EXTENT THOSE DAMAGES ARE PROVEN TO BE SOLEY DUE TO THE COMPANY%NEGLIGENCE. 8.DURING THE DURATION OF THE WORK,THE CLIENT'S HOMEOWNERS INSURANCE WI4 BE RESPONSIBLE FOR ANY AND ALL DAMAGES 9 LONG AS THE COMPANY HAS TAKEN THE APPPOPP RATE ACTION TO PROTECT AT EAS OE WORN. 9.THE COMPANY IS NOT RESPONSIBLE FCR PR OSIISTANG EFFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES WRING THE CONSTRUCTION PROCESS-f 6 WOOD ROT, MOLD,ASBESTOS, NAIL POPS, DUCTWORK ANO CONNECTIONS,PLUMBING AND VENT PIPES DECKING DEMIGOD N, ETC,IF A PPE-EXISTING Of I(IENCY OR HAZARDOUS MATERIAL IS ENCOUNTERED PRIOR TO OR DURING CONSTRUCTIQN,AND COMPANY IS NOTIFIED IN WRONG,CDMPANY WILL TRY TO MEW CLIENT WIT14IN THE COMPANY'S MEANS AND CAPABILITIES TO CORRECT THE PROREEM(Sl ON A TIME AND MATERIAL BASIS,CLIENT AGREES THAT SUCH CONDITIONS ARC tiNAVO(OAM£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 OAT£OF COMPLETION MAY TAPPOFAOMTHHAI AGREED UPON,IF APPLICABLE,UNDER THIS AGREEMENT. 10,TO COMPANY IS NOT RESPONSIBLE,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES,INLCUDING BUT NOT LIMITED TO MOLD GROWTH,ARISING FROM THE PERFORMANCE OF AIR SENDING WORT:.BY THE COMPANY AS ARESULT OF ANY KNOWN OR UNKNOWN MOISTURE CONDITIONS, 11.THE COMPANY 15 NOT RESPONSIBLE FOR,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES RELATING TO ICE OAMMM14G THAT MAY ARISE DURING AND/OP AFTER THE PERFORMANCE OF WORK BY THE COMPANY. 12,REPLACEMENT OF DCOMIORATED DECONG, TASCO BOARDS, RODE WKS. VENTILATORS, FtA$HING. RAFTERS, JOISTS, DNSUTATION DR OTHER MATERIALS ARE NOT INCLUDED UNLESS OTHERWISE NOTED HEREIN, 13.THE COMPANY WILL NOT BE RESPONSIBLE FOR THE SCRATCHING OR DENTING OF INTERIOR WADS ANO CEILINGS.PIWE S,TRIM,GUTTERS,DOWNSPOUTS,EX15TING SIDING AND WD OWYNS,DOORS,OIL OBOPLETS IN DRIVEWAYS,MINING FE CC PES AL,CONCRETE OR BLLCKTOP DRIVES AND WALKS,OR DAMAGE TO WANTS 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 15 REQUIRED TO APPLY FOR AND OBTAIN ALL CONSTRUCTION-RHALOO PERMITS,THE COMPANY SHALL NOT BE DEEMED RESPONSIBLE FOR DECAYS IN THE WORK DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR WSPECTLONAL AGENCIES,RUTHORITIFS,OR INDWIDUALS. 15,THIS AGREEMENT, INCLUDING THE PROVISIONS RETAILING TO PRICE AND PAYMENT SCHEDULE.CANNOT BE CHANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED BY YET'H THE COMPANY AND THE CLIENT, 16.ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS ATILEMENI ARE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND OO NOT SURVIVE THE EXECUTION OF T HIS AGREEMENT. 17,THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRUTEN CONSENT Of BOTH PARTIES EXCEPT IN GTHERWISE SET FORTH HE LEM. 18.THIS AGREEMENT,ANO ANY WARRANTY($(PROVIOFD HEREUNDER SHALL NOT RE ASSIGNED EXCEPT BY OR WITH THE WRITTEN PERM 1551ON OF THE COMPANY. }9.IF THE CLIENT FAE5 TO PERFORM ITS OBLIGATIONS HEREUNDER OR TERMINATES 7HLS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT SHAl1.BE CROP FOR DAMAGES f0 THE GREATER OF THE 61SMPANYS ACTUAL DAMAGES OR 25%OF THE AGREEMENT TOA NESTOCKING FEE. 20.ANY CHANGES TO MATERIALS BY THE CLIENT(BRAND,STYLE,COLOR,ETC.)AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT IN A S%RE STOCKING FEE BASED ON THE COST OF SAID MATERIALS. >1.THIS AGREEMENT SHALL BE EFFECTNE ONLY UPON ITS EXI CCTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPUGL. THE COMPANY RESERVES THE.RIGHT TO REVOKE.THIS PROPOSAL 90 DAYS FROM DATE IT IS CANCELED BY THE COMPANY If IT IS NOT EARLIER EXECUTED BY THE CLIENT AND THE REQUIRED DOWN PAYMENT RECEIVED PALO TO THE EXPIRATION OF SUCH 90 DAY MOD,AFTER 90 DAYS,AND AS THE EVENT COMPANY ODES NOT REVOKE THE PROPOSAL, COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE IN ACCORDANCE WITH ITS COSTS IN ERECT ATSUCH TIME. 21.IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HEED TO BE INVALID OR Uv ENFOREMAE,THE VALIDITY AND BNFORCBBIOP/OF THE REMAINING PROV61ONS OF THIS AGREEMENT MALL NOT BEAME(TED THEREBY. 23.ARBITRATION; IN THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS, CONDITIONS, PROVISIONS, OR PERFORMANCC OF THIS AGREEMENT, THE PARTIES AGREE TO PLACE THE MATTER INTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION ASSOCIATION TO RESOLVE THEIR D6PUTD 24,ANY DISCOUNT, PROMOTION, REIMBURSEMENT,OR OTHER PROGRAM THAT 15 PART'OF A STATE SPONSORED UTILITY PROGRAM RE MASS SAVE") 15 SUBJECT TO THE AVARABNTY OF QDALIF ANG STATE SPONSEREO PROGRAM AND WILL BE SUSPECT TO TERMINATION IF THE STATE SPONSORED UTILITY PROGRAM IS OISCOUNTINUM FURTHERMORE,iHETERMS AHOCANINTONSOF'sTATE SPDN$£REDV6llTN PROGRAMS MAY RE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE. 25,AMERICAN INSTALLERS,LLC IS NOT AN AGENTOF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDERTHC MMLSAVP ENERGY PROGRAM. 26.tt1ENT 15 REP5ONSBt(:FOR THE PAYMENT OF MY ANOALL FEDERAL,STATE.OR LOCALTAKESTHATARE APROGENY TO THISAGREEMENT. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 U11 www.mussgov/dia Workers' Compensation Insurance Affidavit;Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(BaanesslOrgutimLioNindlviduuO: American Installations,LLC Address: 130 College Street,Suite 100 City/State/Zip: South Hadley,MA 01075 _ phone k: 413-552-0200 Are you an employer?Cheek the appropriate bus: Type of project(required): f[M i am a employer with 46 _ 4 ❑ 1 am a general contractor and 1 6. Q New construction employees(full and/or pan-time)." have hired the subcontractors 2.0 1 am a sole proprietor or purtner- listed on the attached sheet.t Q Remodeling ship and have no employees These sub-conVactors have 8. Q Demolition working for me in any capacity. workers'comp. insurance. 9, Q Building addition 1No workers'comp. insurance 5. Q We are a corporation and its IO.Q Electrical repairs or additions required.l officers have exercised their 3 Q I am a homeowner doing alt work right ofexemplum per MOI. 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152, §I(4),and we have no 12.❑ Roof repairs insurance required.I t employees.INo workers' 13 ®00,11. Insulation camp.insurance nequired.l _ '— "Any applicant that checks has N1 mua also fill he,the seebee ml.w showing their workerscompensanon polio,Ihf.nt tu.o r Iemeovmen who submit hu anidavh adichoing they are Juin&all work and o.It.omid....smdors mmt submit o nuw atukayu indica....such. *C..naewn that ebek it,,box must hmehed nn iddidonat sheet shuwmg ae.awe or the sutreanmcmn mM the."workers comp mlK;v htwne tlnn. I am an employer that Is providing workers'mmpemafion insurance for my employees Below is the policy andlnb site Information. Insurance Company Name: Guard Insurance Companies _ policy d or Self--ins. Lie.p: AMWCyy897387_ _ Expiration Date: 091'0(4,,/2018 y� (� r,, Job Site Address:iy3 wayli fwcm _CirylState/Zip:Nnr4h a m�M661OLilo Attack 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 ofMGL c. 152 can lead to the imposition oferimato penahies ofa Pro up to 31,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up In$250.00a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations ofmc DIA for insurance coverage verification. f do herely centfy under the pains an/d� penalliies of perjury that the Information provided l a i'strueand correct ai Phone M 413-55 -0200 Offtcmt use only. Do nor write in this area,to be eompleardby city or=#:_ City or Town: PermiOLicIssuing Authority(circle mi 1. Board of Health 2. Building Department 3. City/Town Clerk 4. or6.Other Contact Person: P 0 CcamnamweaRh of Massachusetts eonsm than supervisor y: Division of Profesvonal Lcensure Unrestrided-Buildigs of any use group vdlkh contain Board of Building Regulations and Standards lassOwn 88,000 Cubic feel(0911 cubic meters)ofenebse0 Construction SOperiisor sem' CS408178 EBpires:09/2912019 - h 218 LAT COUTURE 2118 SOUTH HROLEY-MA 01076 0 , SOUTH NADLEY MI10108 •' .d Failure m presses a Current mw of Lire MewsachuseNs state skawk gCode iscause for revocose of Saw 9eanse. /�L0Fw b abaddes 9es Commissioner Cao(817)121-IMwrvkAwwwmaaegrlddq �'- ���� �arx�jtn�rufefr�l�- afJP��rr�:lfrr�rtself3 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: LLC AMERICAN INSTALLATIONS,LLC. Reipshahon 175982 130 COLLEGE STREET SURE 100 Expiration; 08/282019 SOUTH HADLEY,MA 01075 Update Address and return card. Mark reason for change. SCAT 0 =Z11 r1 Addr= f)gsyu..yi Li Employment CI Lost card .n,m.nm.A,.ndh NOME IMPROVEMENT L CONtRACTOit Insane Me valid tar in date. Nfo sed aonly lu TYPE:LLC hebretl Consumer AtaU. ruai Bu velum to: l r7 J, Rp175962 n W26=19 ONked ConeumM AHalrs antl[Wsilxse Regulation \,;,• 1NS,L 08126@019 to Perk Mas MIS 5190 AMERICAN INSTALLATIONS,LLD, eoeton,MA 02116 WESLEYCOUTURE 130 COLLEGE COLLEGE STREET SUITE 100 Y SOUTH HADLEY,MA 01075 Undersfctetary L valid without Sl9netum A CERTIFICATE OF LIABILITY INSURANCE X8/14/2017 e/14/zov 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 Na ceHllicatir holtler is an ADDITIONAL INSURED,the policy(les)must ITS endorsed. If SUBROGATION IS WAIVED,sub)ect to the 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). PRODUCER NPMEz Lbnds poN r8 Shchher 6 Grinnell PXONE (413)586-0111 FWP% No:14131586-6e81 8 North HiTg Street oar5kiE :lpoNax @NebboramdgriuENell.com INSURE 5 gFFORpXO COVERAGE NAICA Northampton NA 01060 INSURERq to era Mutual Casuelt INSURED WSURERBB.Eks iL0 B8tl18Na GOARD Ing. Co. American Installations, LLC INSURER O: Attn: Nes L SUaaMe Couture INSURER D: 130 College Street, Suite lou INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBERTIastex BSP 9-2018 REVISIONNUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED HASHED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VMTH 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 IN TYPEOFINSUMNCE L POLICY NUMBER MrDD EFY MOL�DryYYY 11MnS COMMERCML GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 -15KA N rI $ 500,000 A OCCUR PREMI$ Ea u SO353521] 9/1/201] 9/4/2018 MED EXP(Any MO eNNR -L-1 0 1 000 PERSONAL S AOV INJURY S 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE $ 2,000,000 R PoLICY�11CT DLOC PRODUCTS 60MPK)PAGG S 2,000,000 OTHER AUTOMOBILE LIABILITY MERGED Ea empenl E uNr 5 1,0001000 A ANY ALTO BDILY INJURY IRar PB15Mj E ATIAUTOS X ASU(CTEUSET) 523535217 9/4/2017 9/4/2D15 BNILYINJURYIPera61ren11 $ NON-0VMEO PR PE tt WMAGE E R HIRED AUTOS R AUTOS Per axlCml PIPEaSIC b 8,000 R UMBRELLA LIAR OCCUR EACX OCCURRENCE E 1 000 000 A EKCFSS LIAR CSAIMSMALE AGGREGATE E 1 000 000 DEO I R I RETENTIONb 10 000 5J353521] 9/4/2017 9/4/2018 S WORKERS LOMPEXSgnOX PER OH- AND EMPLOYERS'LIABILITY r STATUTE ER ANY PROPRIETONPARTNERIExECUTIVE YO XIq EL EACHACOIDENT S SUB 000 OFFICEIRMEMBERY B IMaOEMorr 1e Nin E%CLVOEO] URI 9917 9/4/201] 9/4/2018 EL DISEASE-EA EMPLOYE S $f10000 Xy Eee,"'UMe' OE SC BETTOR OF OPERATIONS EeIaw EL.DISEASE-POLICY IT. 8 500 000 A Commercial Property 5A3535217 9/4/2017 9/./2018 GeEuctida$l WJ DESCRIPTION OF OPERATIONS LOCATIONS;VEHICLES ROUND 101,AmMooel NERI StlYEUk,mry W aNYNM UTon"ace hre9UYed) 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 INS0251w�uln