32C-304 (8) 7 VALLEY ST BP-2019-0416
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-304 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categoly:INSULATION BUILDING PERMIT
Permit# BP-2019-0416
Proiect# JS-2019-000666
Est. Cost:$3600.00
Egg: $65.99 PERMISSION IS HEREB Y GRANTED TO:
on glass: Contractor. License:
1 e ro AMERICAN INSTALLATIONS LLC 106178
Lot Size(sg.ftp: 993 1.68 Owner: SANCHEZ VERNA C&HANS W LEO
Zoning;URC(100)/ Applicant: AMERICAN INSTALLATIONS LLC
AT. 7 VALLEY ST
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413)552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON.101512018 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:
Cas: Eirl Ri ne` t Fireplace/Chimney:
Hough: Oil: Insulation:
Final.- sm2m: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
erkificate qf Occugancy §igmajqr�:
FeeTvpe: Date Paid: Annl2 tt
Building 10/5/2018 0;00:00 $65.00
�12 Main Street,Pattie(41:3)S87=1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only'
ity o Northampton Status of Perrtiit. ,
OCT - 3 2018 uildi g Department Curb Cut/Dnveway Permit
21 Main Street SewerlSepfic•Availabilit)r
oom 100 Water/Well'Avarlabihty
DEPT.OF BUILDING INSPECT ha pton, MA 01060 Two Sets of Structural_Plans
NORTHAMPTOQ3-5871240 Fax 413-587-1272 PIotlSitePlans'
Other'Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AQ/ONE OR TWO FAMILY DWELLING
/
SECTION 1-SITE INFORMATION I[��'' /Ir qlc
1.1 Property Address: This section to be compieteLd,bb office
7 Valley Street Northampton MA 01060
Map ' Lot v Unit.
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Leo &Sanchez,Hans&Verna 7 Valley Street Northampton MA 01060
Name(Print) Current Malin Address:
(413) 586-2912
_See attached Telephone
Signature
2.2 Authorized Agent:
American Installations 130 College St., Ste 100 South Hadley, MA 01075
Name(Print) Current Mailing Address:
q*,,
�e-• CaSU J�A 413-552-0200
Signature j Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 3,600.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) [�
5.Fire Protection
6. Total=(1+2+3+4+5) 3,600.00 Check Number (J
This Section For Official Use Only
Building Permit Number. Date
Issued:
Signature: l /b (Ill $
Building Commissionedlnspector of Buildings Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information {,
Existing Proposed Required by Zoning
This column to be filled in by
Building Department.
Lot Size
Frontage
Setbacks Front
Side L:= R:= L:= R:=
Rear
Building Height -- i
Bldg.Square Footage
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: -----------;I
(volume&Location) —�-- ----� ---------------I
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW Q YES 0
IF YES, date issued:1i
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book I f Page�� and/or Document#I
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 Q Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location: �r
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,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK icheck all applicable)
New House ❑ Addition [] Replacement Windows Alteration(s) ❑ Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[O] Other[f j
Brief Description of Proposed
Work: Attic and basement insulation and air sealing throughout
Alteration of e)asting bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a._If New house and or addition tb existing bousinu..comalete the following:
a. Use of building:One Family Two Family 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 stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
1. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
J. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Hans Leo &Verna Sanchez as Owner of the subject
property
hereby authorize American Installations
to act on my behalf,in all matters relative to work authorized by this building permit application.
See attached 9/29/2018
Signature of Owner Date
I. American Installations as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
American Installations
Printf Name
`
W.AAL" V— . CA'wy . 9/29/2018
Signature of r/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Wesley K. Couture 106178
License Number
130 College St., Ste 100 South Hadley, MA 01075 9129/19
Address Expiration Date
\4-- Q 413-552-0200
Signature Telephone
9.Reaistered'Ho1 a ImproyementContramtorc. Not Applicable ❑
Wesley Couture 175982
Company Name Registration Number
American Installations 6126119
Address Expiration 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,§25C(6))
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....... 11 No...... ❑
11..:=Home Owner Ezemutiori
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 1083.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be
responsible for all such work performed under the building uermit
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts 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: 7 Valley Street, Northampton MA
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
9/29/2018 URQ- , k. ( "�
Date Signature of Permit Applicant
City of Northampton _
Massachusetts
DEPARTMENT OF BIIILDING INSPECTIONS S`•, '
212 Main Street 0ici al Building
Nortton, vbf ,^ePa
Property Address: 7 Valley Street,Northampton MA 01060
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property Owner
Name: Mans Leo &Verna Sanchez
Address: 7 Valley Street
City, State: Northampton MA 01060
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 ` l
Date
_9/29/2018
P _
www.Americaninstallatlons.com
BBB, ►AxnwAnxa
CONTRUMIR . Licensed&insured
\ I MA CSL If.106178
American Installations MA Registration p175982
130 College Street Suite 100,South Hadley,MA 01075 •Office:(4131552-0200 Fax:(413)552-0202• Email:support@Americanlnstallations.cam
Leo&Sanchez,Hans&Verna 8/30/2018
7 Valley Street Northampton MA 01060
IAaanq (CA') o—I (ry)
413-5862912 leosan7@comcast.net
Own.) (wil hm,q
471520 18-2584
Ealewl u.nn
Quantity Unit Unit Cost Total
Air Sealing
AIR SEALING 6 man hour $ 85.00 $ 510.00
WEATHERSTRIP DOOR&ADD SWEEP 2 each $ 80.00 $ 160.00
Air Sealing $ 670.00
Air Sealing Incentive $ (670.00)
Air Selaing WX Balance $
Weatherization
COMMON WALL-2"RIGID BOARD 75 sqft $ 3.85 $ 288.75
CRAWLSPACE-6MIL GROUND COVER 125 sqft $ 0.77 $ 96.25
KNEEWALL-2"RIGID BOARD 390 sqft $ 3.85 $ 1,501.50
KNEEWALL-FIBERGLASS R13 180 sqft $ 1.40 $ 252.00
KNEEWALL FLOOR-3"UNFACED R-13 FG BATT 210 sqft $ 1.40 $ 294.00
FINISHED KNEEWALL ACCESS 2 each $ 135.00 $ 270.00
SHEATHING ACCESS 5 each $ 35.00 $ 175.00
Total Weatherization $ 2,877.50
Weatherization Incentive $ 2,158.13
Total Project $ 3,547.50
Total Utility Contribution $ 2,828.13
Total Customer Contribution $ 719.38
WARRANTY:American Installations,LLC will provide the above stated homeownerwith a 2 year workmanship warranty,
American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building
regulations for the Total Contract Value as stated herein.
ACCEPTANCE OF PROPOSAL:The above prices,specifications and TOTAL CONTRACT VALUE_ $ 719.38
conditions are satisfactory and are hereby accepted.You are
authorized to do work as specified.Payment will be 1/3 down prior to Down Payment= $ 200.00
+rt of work,a -lance due upon Completion. PAID
Balance Due Upon Completion= $ 519.38
it'law-- 8/30/2018
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nPP�lr w.nNlnwl w.PHIr owne pk�l Dm
Chris Bach 8/30/2018
AnM...+4Rve IhEn11 Ame.am.orelllDR Oa,e
Th x AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIOE OF TATS PAGE AND NSALL DE CONSIDERED THE ENTIRE AGREEMENT aY THE PARTIES INVOLVED.IVIS AGREEMENT IS RETWE.EN AMERICAN INSTALUTIONS,EEC HEREINARm
REFERRED TO AS'COMPANr.AND THE CUSTOMERIS)NAMED ABOVE.HEREINAFTER REFERRED TOM'CLIEW.AND Will 9E SUDLECI TO All APPROPRIATE LAWS,REGULATIONS Mn OROINANCF5 OF ill[STATE OF MMSACHUMB5 OR CONMOICUT
RESPECTIVELY,AS WELL MAIL LOCAL AMISDICTIONS.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leiibly
Name (Business/Organization/individual): American Installations,LLC
Address: 130 College Street, Suite 100
City/State/Zip: South Hadley,MA 01075 Phone #: 413-552-0200
—Are
Are you an employer?Check the appropriate box: I 'hype of project(required):
1.Q 1 am a emplover with 60 4. ❑ 1 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 ?. El 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 j
l0.❑ Electrical repairs or additions
3_❑ 1 am a homeowner doing all work right of exemption per MGI, I I.[] Plumbing repairs or additions
mvself. [No workers'comp. c. 152,§1(4),and we have no 12.F-1 Roof repairs
insurance required-I t ^ employees. [No workers' — j
comp_ insurance required.] 13. Other Insulation --JI
*Any applicant that checks box ffl must also till out the section below showing their workers'compensation policy information.
i I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Guard Insurance Companies
Policy#or Self-ins. Lic. #: URWC609917Expiration Date: 09/04/2019 ,
Job Site Address: City/State/Zip: 2n AA O o
Attach a copy of the workers'compe6sation 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:tip 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
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Si nature: __ Date: _0 �I
Phone#: 413-55f-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 Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
Commonwealth of Massachusetts Construction Supervisor
Division of Professional Licensure Unrestricted-Buildings of any use� group which contain r Board of Building Regulations and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed
Construction Supervisor space.
CS-106178 Expires:09129/2019
WESLEY COUTURE
218 LATHROP-STREET
SOUTH HADLEY MA 01075
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Commissioner Call(617)727-3200 or visit www.mass.gov/dpi
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: LLC
AMERICAN INSTALLATIONS,LLC. Registration: 175982
Expiration: 06/26/2019
130 COLLEGE STREET SUITE 100
SOUTH HADLEY,MA 01075
Update Address and return card. Mark reason for change.
SCA 1 0 20M-05111
n n o--is,--r--1 n En1plQymeni 0!Qstcara
' Office of Consumer Affairs&Business Regulation
r ; HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
t TYPE:LLC before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
175982 06/26/2019 10 Park Plaza-Suite 5170
AMERICAN INSTALLATIONS,LLC. Boston,MA 02116
WESLEY COUTURE �C --
130 COLLEGE STREET SUITE 100 _
SOUTH HADLEY,MA 01075 Undersecretary valid without signature
AC4 RVQ CERTIFICATE OF LIABILITY INSURANCE DATE(MUM 8 Y)
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 policy(ies)must be endorsed. H SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsemem A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(*).
PRODUCER C NTAE•CT Linda Powers
Webber & Grinnell PHONE . (413)586-0111T-FAX
(413)586-6481
8 North Ring Street E-MAa .1Doweraftebberandgrinnell.coml
INSURER AFFORDING COVERAGE NAIC If
Northampton KA 01060 INSURERA:Mmployers Mutual Casualty
INSURED INSURER B:Berkshire Hathaway GUARD ins. Co.
American Installations, LLC INSURER C:
Attn: Was & Suzanne Couture INSURER D:
130 College Street, Suite 100 INSURER E:
South Hadley KA 01075 INSURER F:
COVERAGES CERTIFICATE NUMBER.-master Exp 9-2019 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.
INDDLSUBR
LTSRR TYPE OF INSURANCE A POLICY NUMBER POLICY EFF POLICY EXP MMMOMMI LIMITS
COMMERCIAL GENERAL UAML17Y EACH OCCURRENCE $ 1,000,000
A x PREM
CLAIMS-MADE 7 OCCUR DAMAGE R occurtence $ 500,000
ISESEa
5D3535217 9/4/2018 9/4/2019 MED EXP(Any oneperson) $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
x POLICY F--I ECT F�LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000.000
(EaAANY AUTO BODILY INJURY(Per person) $
ALL OWNED x SCHEDULED 523535217 9/4/2018 9/4/2019 BODILY INJURY raccident) $
AUTOS AUTOS
x HIRED AUTOS x NON-OWNED PROPERTY DAMAGEAUTOS (Per acckbant) $
-1i
x Coil$2,000 X conpS2,000 PIP-Basic $ 8,000
It UMBRELLA LIABOCCUR EACH OCCURRENCE $ 1,000,000
A EXCESS UAB HCLAIMS-MADE AGGREGATE $ 1,000,000
DED I x I RETENTION 10 000 5J3535217 9/4/2018 9/4/2019 $
WORKERS COMPENSATION x PER OTH
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH AOMDENT $ 500,000
OFFICERIMEMBER EXCLUDED? ❑NIA
B
(Mandatory In NH) URMCG09917 9/4/2018 9/4/2019 E.L.DISEASE-EA EMPLOYEE $ 500,000
If Yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000
A Camaercial Property SJL3535217 9/4/2018 9/4/2019 deducriNe$1,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addidonal Remarks Schedule,may be attached H more apace Is required)
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 REPRESENTA17VE
W Grinnell, CPCU, CIC
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025(201401)