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28-056
125 SYLVESTER RD BP-2019-0256 CIS#: COMMONWEALTH OF MASSACHUSETTS Mao Block: 28-056 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-2019-0256 Project JS-2019-000411 Est.Cost:$6600.00 Fee:$65.00 PERMISSIONIS HEREBY GRANTED TO: Const.Class: Contractor: License. Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(so.ft.): 655578.00 Owner. RANNEY DOUGLAS C Zoning: Applicant. AMERICAN INSTALLATIONS LLC AT: 125 SYLVESTER RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 SOUTH HADLEYMA01075 ISSUED ON:8130/2018 0:00:00 TO PERFORM THE FOLLOWING WORK ATTIC & BASEMENT INSULATION &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: FeeTvoe: Date Paid: Amount: Building 8/30/20180:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner File#BP-2019-0256 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS THONE 130 COLLEGE ST SOUTH HADLEY (413) 552-0200 PROPERTY LOCATION 125 SYLVESTER RD MAP 28 PARCEL 056 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED O Fee Paid /,;/if P& (� Buildi.gPermitFll d oA Fee Paid Tweof Coristraction, ATTIC&BASEMENT INSULATION&AIR SEALING THROUGHOUT New Constriction Non Structural interim renovations Addition to Existing Accessory Structure Building Plans Include& Owner/Statement or License 106178 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: _Approved_Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay /1 6 z Signatur Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission, Department of public works and other applicable permit granting authorities. - Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. RECEIVED DepaNnent use oml C., of Northampton Status of Permit; B ing Department Curb CutlDrWeWay Permit AUG 2 7 2018 12 Main Street sews asps°AyallabH[y. . Room 100 We1arAVell`Ava®eb9iy... ort mpton, MA 01060 Tyro sets of awcbrrelAaice oEPLOFeUmiwir healag3-6 7-1240 Fax41&587-1272 1*#§te Pians . NORTHAMPTON Dim APPLICATION TO CONSTRUCT,ALTER,REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION bP-lq:a 1.1 ProoertyAddress: This section W be completed byalfice j-jL_ 125 Sylvester Road, Florence MA 01062 Map, Lot nae int. Zone Oveday Dlstdat Elm SL Disbkt OB Diablo( SECTION 2-PROPERTY OWNERSHIPIAUTHOROFngGENT 2.1 Owner of Record: DOuQlas Ranney 125 SMylvester Road, Florence Name(Rim) (413)58-551+511 s: See attached Talephona Slpnatum 2.2 Authorized Anent: American Installations 130 College St., Ste 100 South Hadley, MA 01075 (Pi" umd NlhV AIX -Z— y= 413-552-0200 sig — TaMpharm SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only ebed by Permits &ant 1. Building 6,600.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of ConeWgkn from 3. Plumbing Buntung Permit Fee 4. Mechanical(WAC) uc 5.Fee Protection 6. Total= 1+2+3+4+5 6,600.00 Check Number 111970.6 Ibis Section For ORkial Use Only BulWing PenWt Number. Dole Issued: Signature: Bunft Commi abrwrgnepador of BuMinge Date 1 Section 4. ZONING All IMmpwdon hunt Be Completed.Penal Can Se Dented Due To hJarmatbo Existing Proposed Req ' by atqB This Wto fill�tnby 'iNa Bo I.otSize Setbacks Front p Side LI�1t= I.= R:= 0 C� Rear Building Height Bldg.Square Footage C� C� % Open Space Footage % r— Q.ot este mtaw bldg a pav W #of Parkin S Fill: voiuma&Lace" A. Has a Special Permit/Varlance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES,date issuedi___� 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 RF 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 Cowervatkm 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 conaWetlon aeAft disturb Ideadrg,grading,excavagon,or SIV)over l sore or is K pad of a common plan thatwlll disturb over lam? YES O NO O IF YES,than a Northampton Storm Water Management Permit horn the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK LrjMck all applicablel New House ❑ I Addition ❑ Replacement Windows Alterattoncsl p Roo" p Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs ll7] Decks Ip SMing0m) Other[EN Brief Desaiptlonof Proa." Work: Athc and basement insulation and air sealing throughout Axeratioh ofebsting bedmwn_Yes_No AddhVnewbedroom Yes No Attached Narrative Plans Attacher)Roll -Sheet Renovatlng unMtshed basement _Yes No So.It New house and or addition to existing-housino -complete the following: a. lyse of building:One Family Two Fordy o0ar b. Number of rooms In each femfly,unit Number of Bathnmms c. Is them a garage atlsdred7 d. Proposed Square footage of new mnstmcdon. Dimensions e. Number of stories? f. Method ofheatlng? Fireplaces mWoodstavea Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance forth attached? h. Type of construction I. Is construction within 100 it.of wetlands?_Yes _No. Is censbuctlon within 100 yr. floodplain-Yes—No I. Depth of basement or colorfioor below finished grade k. WIII building conform to the Sutding and ZoNng regulations? —Yes—No. I. SePticTank_ qty Sewer_ Privatewell_ Ckywater Supply_ SECTION To-OWNERAUTHORRATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMR L Douglas Ranney as Owneroftiresubject Property hembyauthorize American Installations to act on my behalf,in all matters relative to work authorized by this building permit application. See attached 8/23/2018 Slprehna of owner Dela I, American Installations .as Omho/Aulhortzed Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the hest of my knowledge and belief. Signed under the paths and penalties of perjury. American Installations Print Name �.9h V 8/23/2018 SlgnaWre of Dote SECTION S-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not ApplicaNe ❑ Nnmeof Lieeeee Holds, Wesley K. Couture 106178 Lienee Number _130 College St., Ste 100 South Hadley, MA 01075 9/29/19 Address Expiation Dag L V- �1A�,413-552-0200 Signature —j Telephone 9.Registered RomknDmipmerit Contractor. _ - Not Applicable ❑ Wesley Couture 175982 Comoanv Nama Registration Number American Installations 6/26/19 Address 5cpiretlm Dag 130 College St., Ste 100 South Hadley, MA 01075 Telephone 413-552-0200 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S)) 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 penNL Sitped ABhtavitABached Yea....... IN No...... O 11.,Home Owner.Esemntion The tenant ezemptionfor"homeowners"waseXmnded to include Owner.oecupled Deretlinea ofoae(1) or two(2)fimikes and to allow each homeowner to engage an individual for him who does net possess a license,`provided that the owner Rets as saoervisor.CMR 780, Sixth Edition Section 10835.1. Definition ofAomeowmer:Person(s)who own a patent of land on which he/she resides or Wends to residF on which there is,or is intended to be,a we or two family dwelling attached or detached sbucbmes accessory to such use and/or farm Stuctues.A person who onstructs mom than me home In a two-vear Period sh U not be dd ed a homamm . Such-homeowner-shall submit to the Building OtEcial,on aSam acceptable to the Building Ofcial that hdaheshag he tvimansible for all such workPerformed ander thbutidinaPenn% As acting Copatruction Supelyimr you presence ontbe 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'Compensation) and Chapter 153(Liability ofEmptoynea to Employees for igryres me resulting inDeath)ofthe Massachusetts General Laws Anmgted,you near be Bake forperson(s) you hire in perform work for you under this pemit The undersigned"homeowner'certifies and aemmes responsibility for compliance with the State BuldmgCode,City of Northampton Ordimamces,State and Local7=iog Laws and State ofManeechoaetts General Laws Amended. 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: 125 Sylvester 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 Wesley Couture 8123/2018 k- . Q Date Signature of Permit Applicant • mass save "^R 1etl PARTNER AaA css v:rar>A ALA aapdani L os. American Installations ""1Y A'n°f1eanlnsbnaaans.aan an fdeasneel sWe spq Spuq awaey.Elnmms.ORb:MST sszomp x.:laN ssLoffi.unelE aypwtµ,e[eanwuw4ona[wn Customer Name:Doug Forney Email:Not provided Phone:413-584-5150 Premise Address:125 Sylvester Rd,Northampton, MA 01062 Project 1o:3456976 Di Aug. 22,2018 Job Description Air Sealing at Estimated 62.5 CFM50 Per Hour 4 hr $370.32 $0.00 Exterior Door Weather Stripping (with AShrs) 3 each $90.21 $0.00 Door Sweep (with AS most 3 each $75.93 $0.00 Rim Joist-6" Fiberglass Batting 70 SF $189.00 $47.25 Kneewall Slope-6" Fiberglass Batting 500 SF $1,065.00 $266.25 Kneewall Slope - 2"Thermal Barrier Polyiso 500 SF $2,390.00 $597.50 Kneewall Gable Wall - 3" Fiberglass Batting 40 SF $76.40 $19.10 Kneewall Gable - 2'Thermal Barrier Polyiso 40 SF $191.20 $47.80 Attic Slope 6" Dense Pack Cellulose 436 SF $1,229.52 $307.38 Attic Floor- 12" Open Blow Cellulose 400 SF $816.00 $204.00 Damming 16 each $38.24 $9.56 Hatch - 2"Thermal Barrier Polyiso 1 each $46.28 $11.57 Project Total $6,578.10 Weatherization incentive ($4,531.23) Air sealing incentive ($536.46) Total Program Incentive -$5,067.69 Customer Total $1,510.41 WAnMmY:Amen[a.iratylad.,LLC w'p,vidai.—.Kaenm —rad canna In ear wureneranlp—lartY Mµn[an IAUMIMML,LLC herein wtodaaa mfwaN all mtenal and Iffim mCom[IKetne abnre[[ope ofv knaLcmdurcewiththeabow sne irkadonsandall lmaardatah build,nMaab¢M fM Na T..vide...term ACCEWAME OF MOF'OVAL M al— Fai yeUhMbns and FFna a are iOTALCONfMG VALUE+$ 151041 amna[m.y Mtl Ke M1Kebr Kapae.vn„artaanonemro mwnn as apa[inaa.=KMMt mwn p.w„em•5 $00110 ❑ x ibelAM' pdwtldM&wa ,MdbalameduetpMCdnpINM. "15 aaM[e one upon fomplttbn• s 1010.41 semi / cam 8/22/18 Roden,UV,.IpnML Sien roe eMrezematao i Ethan Seeman tsmi Ethun SeonxE. Dara 8122118 THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE END RE AGREEMENT BY THE PARTIES INVOLVED. THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS`COMPANY",AND THE CUSTOMERS)NAMED ON THE REVERSE SIDE,HEREINAFTER REFERRED TO AS"CLIENT",AND WILL BE SUBJECT i0 ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STALE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL M ALL LOCAL JURISDICTIONS. THE FOLLOWING TERMS AND CONDITIONSALSO APPLY L. THIS AGREEMENT ISSUOIECTTO THE APPROVAL OF A MANAGER OF THECOMPANY FOR THIS AGREEMENTTO BE EFFECTIVE UNDER ANY CONDITION - 1. SHOULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF)11/3) PERCENT PER MONTH.JIM PER ANNUM)WITH A MINIMUM CHARGE OF$2 W PER MONTH,AND IF PLACED IN THE HANDS OF AN ATTORNEY ORCOLLECTION AGENCY FOR COLLECTION,ALL ATTORNEYS'FEES,EXPENSES AND COSTS OF COLLECTION SHALL OE PAID BY THE CUENT. IN ADDITION,CLIENT UNDERSTANDS THAT IN FAILING TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY HAVE THE RIGHT TO A LEI 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. 4. COMPANY AGREES THAT,NOTWITHSTANDING ANY AGREEMENT FOR MATERIALS AN D/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY IS RESPONSIBLE TO CLIENT FOR COMPLETION OF ALL WORK DESCRIBED IN A UNITY AND WORKMANLIKE MANNER. 5, ALL WARRANTIES FOR EQUIPMENT AND PRODUCTSSUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BYTHE MANUFAMR ERS 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 AND/OR PRODUCTS IN ORDER TO ACTIVATE SUCH WARFANTIES. 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 OR COST SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT. i. THE COMPPNYS III FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AGREEMENT PRICE EXCE PT TO THE EXTENT THOSEDAMAGES ARE PROVEN TO BE SOLEY DUE TO THE COMPANY'S NEGLIGENCE, 0. DURING THE DURATION OF ME WORK,THE CLIENT'S HOMEOWNERSINSURANCE WILL BE RESPONSIBLE FOR ANY AND ALL DAMAGE AS LONG AS TILE COMPANY HAS TAKEN THE APPROPRIATE ACTION TO PROTECT AREAS OF WORK. 9, THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS, E.G.WOOD ROT,MOL,ASBESTOS,NAIL POPS,DUCTWORK AND CONNECTIONS,PLUMBING AND VENT PIPE,DECKING DEFLECTION,ETC, IF A PRE EXISTING DEFICIENCY OR H CIARCOUS MATERIAL IS ENCOUNTERED PRIOR TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING,COMPANY WILL MY TO ASSIST CLIENT WITHIN TILE COMPANY'S MEANS AND CAPABILITIES TO CORRECT THE PROBLEM(S)ON A TIME AND MATERIAL BASIS. CLIENT AGREES THAT SUCH CONDITIONS ARE UNAVOIDABLE BY ME 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 APPLKABLE,UNDER THIS AGREEMENT. 10. THE COMPANY IS NOT RESPONSIBLE,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS ANO/OR DAMAGES,INLCUDING BUT NOT UMITED TO MOLD 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 WENT AGREES TO HOLD THE COMPANY HARMLESS,FDA ANY PROBLEMS AND/OR DAMAGES RECITING TO ICE DAMMING THAT MAY ARISE DURING AND/OR AFTER ME PERFORMANCE OF WORK BY THE COMPANY. 11. REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,RODE JACKS,VEMMTORS,FLASHING,EWERS,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 CEIUNGS,FLOORS,TRIM,GUTTERS,DOWNSPOUR,EXISTING SIDING AND WINDOWS,LOCI OIL DROPLETS IN DRIVEWAYS,HAIRUNE FRACTURES IN CONCRETE OR BLACKTOP DRIVES AND WALK$OR DAMAGE TO PLANTS OR SHRUBBERY. IF"CESAVE DAMAGE IS CAUSED BY COMPANY,COMPANY WILL REPAIR OR REPLACE DAMAGED AREA ONLY AT COMPANYS EXPENSE. 14, THE COMPANY UNDER PROVISIONS OF CHAPTER 143A OF THE GENERAL LAWS IS REQUIRED TO APPLY FOR AND OBTAIN ALL CONSTRUCTION-RELATED PERMITS. THE COMPANY SHALL IAT BE DEEMED RESPONSIBLE FOR DECAYS IN THE WORK DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR INSPECTIONAL AGENCIES,AUTHORITIES,OR INDIVIDUALS. 15, THIS AGREEMENT,INCLUDING THE PROVISIONS RECIIING TO PRICE AND PAYMENT SCHEDULE,CANNOT BE CHANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED BY BOTH THE COMPANY AND THE CLIENT 16. ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT PRE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND DO NOT SURVIVE ME EXECUTION OF THIS AGREEMENT. 17. THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN. 18. THIS AGREEMENT,AND ANY WAMIAMY)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 R%OF THE AGREEMENT FOR RESTOCKING FEE. 20. ANY CHANGES TO MATERIAE BY THE CLIENT(BRAND,STYLE,COLOR,FTC.)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$AID MATERIALS. Zl, THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL THE COMPANY RESERVE THE RIGHT TO REVOKE THIS PROPOSAL 9D DAYS FROM DATE IT 15 EXECUTED BY THE COMPANY IF IT IS NOT EARLIER EXECUTED BY THE CLIENT AND THE REQUIRED DOWN PAYMENT RECEIVED PRIOR TO THE EXPIRATION OF SUCH SO DAY PERIOD;AFTER W DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE PROPOSAL COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE IN ACCORDANCE WITH ITS COSTS IN EFFECT AT SUCH TIME. 31, IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE,INE VAUDITY AND ENFORCEBILITY OF THE REMAINING PROVISIONS OF THIS AGREEMENT SHALL NOT BE AFFECTED THEREBY, 23. ARBITRATION IN WE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS,CONDITIONS,PROVISIONS,OR PERFORMANCE OF NIS AGREEMENT,THE PARTIES AGREE TO PEACE THE MATTER INTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION ASSOCIATION TO RESOLVE THEIR DISPUTE, 34. ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM LLE.MASS MVE')6 SUBJECT TO THE AVAILABILITY OF QUALIFYING STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF ME STATE SPONSERED UTILITY PROGRAM IS DIKOUNTINUED, FURTHERMORE,THE TERMS AND CONDITIONS OF STALE SPONSORED UTILITY PROGRAMS MAY BE ALTERED OR UPEATED PERIODICALLY WITH OR WITHOUT NOTICE. ]S. AMERICAN INSTALLERS,LLC 15 NOT AN MEW OF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE'ENERGY PROGRAM. 36, CLIENT IS REPSONSIDLE FOR THE PAYMENTOF ANYANDALL FEDERAL,STAN,OR LOCAL TAXES MATARE APPLICABLE TO THIS AGREEMENT The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations wi 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansiPlumbers Applicant Information Please Print Legibly Name(Bmioeo/OfgmlimtioNlndiridual); American Installations,LLC Address: 130 College Street,Suite 100 City/Stale/Zip: South Hadley,MA 01075 Phone #: 413-552-0200 Are you an employer?Check the appropriate box: Type ofprojcet(required): 1.❑x 1 am a emplover with 46 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-lime).• have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ 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 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all woe, right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers'comp. c. 152.§I(4),and we have no 12.❑ Roofrepairs insurance required. r employees. [No workers' camp. insurance required.] I3.[�Other- Insulation `Any appliwnl Ihar checks box#I must xlm fill uuuhu zedinn blow showina rllcir woAen'camnmaaspn poiky irf mi.fon. t Irnnno. min whosu ura,h.affidavit mdiolina Nryaredoingall Work and Nen M1im o,asidu cunsracmrs meSl submit opals alliaavie in4icWina such. :ConvocmnThal chink rM1a box mun Wuched an addirionel shttr slmwina Ihu name of rhe sub<oWmWon and Nuir workrn'corm,.I ticv inroanasion. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information Insurance Company Name: Guard Insurance Companies _`_ Policy#or Self-ins.� J Lic.#: CAMWC897387_ . Expiration Date: 09/04/2018 Job Site Address: l a— , u {gA City/SMWzip:_Eila n I INF DI t`A Attach a copy of the workers'c mpeasetios 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 ofa STOP WORK ORDER and a tine of up 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 for insurance coverage verification. I do hereby aenify under the pains an�]d p�ens,�d,e�ss.yo�f p�erjury that the informadon provlded a ve is true and correct. S'anatureth��yac?�rl/Bm1 �. l ./Y7LLl.(l Ls� _ Uate: _._ 2 ._ Phone#: 7 413-552"0200 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of f-eelth 2.Building Department 3.Citylyown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Conor onweakh of Massachusetts Collwrtlion SupeYreor ®: DNision of Protnkorul Licensure Unreatrlded-13UPOW or My rus WWP WNdIl contain Board of Sudding Regulations and Standards rasurn 35AM MING het(991 crwc metes)orerldond ConSVWu Ubn Supervisor CS-JD6178 E;pirm:09/2912019 WESLEY couTuRE 219 LATHROP'bTREEr m SOUTH HADLFgY MA 01079 canonto ft cod acumen,,fowohne Massee kw" see Bulla9r9 Daae b twee for reYaeadon Of 0,15 9attw. C`p out Far haomrtlon abd"11 e Cornmissioner "� Cw 19'17)727-M00 or Ask wwwm aoWdpt Z'. r/k, 16"oJ lIfif)Nf(t£'-71111 01(-)A7.1JaVf'7(es" fS Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: LLC AMERICAN INSTALLATIONS,LLC. Registradon: 175982 E)Ontlon: 00/28/2018 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Updrta Adds aM Mum Md. Mark rwson for cmws. SCAI O 2010AS91 Ada — r0___..I 17 EMI emedf 131 991 CArd L. HOME IMPROVEMENT Mre a CONTea Rpuhtlon 11 �y HONE INPROYEMEHr CONTRACTOR Ref re itre n valid for IMo. If found use o , TYPE:LLC eebnof Co retlondafa. arrd8 Mum to: Omw of an,-Su 51" antl suNnw,Rpulellon 1]5902 08128/'Ni9 10 Park Raxa-9uM 61]0 AMERICAN INSTALLATIONS,LLC. B rI,MA 02119 WESLEY COUTURE WE COLLEGESTREET SUITE 100 r SOUTH HADLEY,MA 010]5 Undelseoretwy YBlid without Signature ACO m CERTIFICATE OF LIABILITY INSURANCE D8/14/20017 ia-i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the mfcy(iss)must be endorsed If SUBROGATION IS WAIVED, subject to the farms and conditions of the policy,certain policles may require an endorsement A statement on this certificate does not confer rights to the ce"I icate holder in lieu of such endorsemeards). PRODUCERNTA T NAME: Linda POpeLa Webber L Gar!nne11 PNDNE (913)586-0111 FNC No:Ib131586-6481 8 North Sing Street Apes.IPoxera8arebberandgri nell.com INSURENS)AFFORDING COVERAGE NAID Northampton !BL 01060 INSVRERAEm 10 eLs Mutual Casualty INSURED INSVRERBBerkshire Hathassay GUARD Ina. CO. American InatallatlOna, LLC INSURERC: Attn: Meg 6 Suzanne Couture INSURER D: 130 College Str6et, Suite 100 INSURER E: Routh Hadley HIL 01075 PAURERF: COVERAGES CERTIFICATE NUMBER3faater 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. PERPOLICY EFF POLICY UP LIMITS Lny TYPE OF INSURANCE POLICY HUMBER M6VOD.MY MMIC COMMERCIAL GENERAL UABILItt EACH OCCURRENCE b 1,000,000 A A CIAIMSMACE OCCUR PREMISESEe—me $ 500,000 SO3535210 9/4/2017 9/4/2018 MED ESP(Any ore lrenOn) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENL AGGREGRTE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 R POLICY❑PRO JECT 1:1 LOC PRODUCTS-COMPAPAGG S 2,000,000 OTHEN AUTOMOBILE UABILItt Eae lGsnl MUyI SINGLE LIMIT $ 11000,000 A Am ASO BODILY INJURY(Per Fereon) $ AUTOS ALL ED y' AUTOB LED SE35352D 9/4/2017 9/4/2018 EDGILY INJURY(Par—AAQ $ NON-0WNEO PR PERTY DAMAGE S A HIRED AUTOS 7` AUTOS PerecuOMi PIP-Se6Io s 8,000 A UMBRELLA LAB OCCUR EACH OCCURRENCE $ 1,000,000 A E%CEA LIAR CLQMSAIADE AGGREGATE E 1,000,000 LED I A I RETENTIONS M000 5J3535217 9/4/2017 9/4/2018 $ MIU EA COMPENSATION x STATUTE OERH AND EMPLOYERSLIABILITY ANY PRWRIETOWPARTNEN1EA1CUTIVE YO NIA El EACH ACCIDENT S 500,000 OFFICEPARMSER EXCLUDED? B Iryoymry In an u C609917 9/4/2017 9/4/2018 E L.DISEASE�EA EMPLOYE $ 500,000 Ifeeemm neer DEBOR PTION OF OPERATIONS NJI E DISEASE-POLICY LIMIT I S 500,000 A Commercial Property SA3535217 9/4/2017 9/4/2018 EeloulSle$1JMA DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES RODRD 101,MOXlwul Rereame SM1eEule,may Ge eWd1M Nmme ary[e Is reasm l) 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. AVTHORMEO REPRESENTAnVE Kevin Joyce/LMP ©1988-2016 ALONG CORPORATION. All rights reserved. ACORD 25)2014/01) The ACORD name and logo are registered marks of ACORD INS025 rmlmn