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36-099 (11)
981 BURTS PIT RD BP-2019-0715 GIs#: COMMONWEALTH OF MASSACHUSETTS Map Block: 36-099 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-2019-0715 Project# JS-2019-001169 Est. Cost: $3800.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq.ft.): 22956.12 Owner: POPIELARCZYK EDWARD J JR&ADELE A Zoning: Applicant. AMERICAN INSTALLATIONS LLC AT.- 981 BURTS PIT RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:12/17/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-ATTIC AND BASEMENT INSULATION AND AIR SEALING THROUGHOUT POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 12/17/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner -t:/vs U L.,14 T/Ori/ i-- Department'use only r-+E! ® ity of Northampton Status of Permtt V itding Department Curb Cut/Dnveviray Permit 212 Main Street Sewer/Septic Availability DEC 1 3 2018 Room 100 waterlwenAvailability'. No ampton, MA 01060 Two Sets of Strercturalal Plans 13- 7-1240 Fax 413-587-1272 ji6t/Site.Plans`: DEPT of Eui��T ,MAo�oso N Other.Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 6R, l q- '716- 1.1 7`6- 1.1 Properly Address: This section to be completed by office Map Lot U Unit. 981 Burts Pit Road, Florence MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Popielarczyk,Edward&Adele 981 Butts Pit Road, Florence MA 01062 Name(Print) Current Mailing Address: (4I-A) SR4-7675 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 LA y—. �, 413-552-0200 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $3,800.00 (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) $3,800.00 Check Number 3 This Section For Official Use Only Building Permit Number. Date Issued• Signature: / /2-N"/9 Building Commissionedinspector 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 Bldg.Square Footage Open Space Footage J % i--- (I.ot area minus bldg&paved parking) #of Parking Spaces r--� (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES Q IF YES,date issued-1 E 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# 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 0 , Date Issued: C. Do any signs exist on the property? YES © 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,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. r SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[tj Brief Description ofproposed : A Workttic and basement insulation and air sealing throughout Alteration of existing 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 Ab existing housind..complete 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 I. 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, Popielarczyk,Edward&Adele 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 12/12/2018 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 Print Name V— ObAkyjKL 12/12/2018 Signature of OwAer/Agent Date i 1 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 9/29/19 Address Expiration Date \LAx.&A Y- • CUUCV-, , 413-552-0200 Signature Telephone 9.Registered Flome Improvement Contractor.,. Not Applicable ❑ Wesley Couture 175982 Company Name Registration Number American Installations 6/26/19 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 budding permit. Signed Affidavit Attached Yes....... 0 No...... ❑ 11. =^Home Owner:Exemption 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 helshe shall be responsible for all such work performed under the building permit. 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: 981 Burts Pit Road, Florence 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 12/12/2018 Date Signature of Permit Applicant mass save -icensed&insured FARTHER MA Cu % k:lf178 MA Registration p 175982 American Installations www-Americaninstall ations.cam 130 college Street Suite 100,South Hadley,MA 01075• Office:(413)SSZ-0200 Far:(313)552.0202• Email:supportLeAmericaniestallationscom Customer Name:Edward Popielarczyk Email:Not provided Phone:413-584-7675 Premise Address:981 Burts Pit Rd, Northampton, MA 01062 Project ID:3613026 Date:Dec. 11,2018 Job Description Co Measure De�scripition vocation Quantity Unit Cst CtistQmst Cost Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Living 12 hr $1,110.96 $0.00 Space Rim Joist- 6" Fiberglass Batting Living 48 SF $129.60 $32.40 Space Attic Floor- 6"Open Blow Cellulose Living 1160 SF $1,879.20 $469.80 Space Bath Fan Hose Living 2 each $52.40 $13.10 Space Hatch - 2"Thermal Barrier Polyiso Living 1 each $46.28 $11.57 Space Whole House Fan Box - 2"Thermal Barrier Polyiso (with Living 1 each $187.70 $0.00 AS hrs) Space Kneewall Wall - 2" Thermal Barrier Polyiso Living 34 SF $162.52 $40.63 Space Exterior Door Weather Stripping (with AS hrs) 3 each $90.21 $0.00 Door Sweep (with AS hrs) 3 each $75.93 $0.00 Project Total $3,734.80 Weatherization incentive ($1,702.50) WARRANTY:American installations,LLC will provide the above stated homeowner with a i-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-'otal Contract value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRAC-VALUE satisfactory and are hereby accepted.You are authorizedto dowork as specified.Payment Down Payment=S ❑ will be 1/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion= Signature Date Page 1 of 2 Property Owner(Print) (Sign; Date Representative:(Print) (Sign) Date T HIS AGREEMENT IS LONIPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE ANO SHALL BE EM51DERED THE ENTIRE AGREEMENT BY THE PART IES INVOLVED'MIS AGREEMENT IS BETWEEN AMERICAN INS'ALHA DONS,LLC HEREINAFTER REFERRED TO AS*COMPANY'. ANDTHE W STOIVERi S)NAMED AEOVE.HEREINAFTER REFERRED TC A5'QIENT'.ANO WILL RE SUBJECT TOALL AP PRCPRIATE LAWS,RE5UTATION5 AND ORDINANCES OF THE STATE Of MASSACHUSETTS OR LONNECTICU'RESPECTIVELY.AS WELL AS Al LOCAL 1URISDI 7ICN5 mass save _icensed&Insured PARTNER MAcu a.1061M MA Registrotlon#175982 American Installations www.Americaninstallations.com 130 College Street Suite 100,South Hadley,MA 01075•Office:(413)552-02oo Fax:(413)552.0202• EmaiL support@Americanlnstallations.com Customer Name:Edward Popielarc2yl< Email:Not provided Phone:413-584-7675 Premise Address:981 Burts Pit Rd,Northampton, MA 01062 Project ID:3613026 Date:Dec. 11,2018 Air sealing incentive ($1,464.80) Total Program Incentive -$3,167.30 Customer Total $567.50 WARRANTY:American installations,LLC will provide the above stated homeowner with a L-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 notal Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE=5 567.50 satisfactory and are hereby accepted.You are authorized to dowork as specified.Payment Down Payment=S 100.00 © 12-11-18 will he 1/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion= 5 467.50 SignatureDate 12-11-18 Po ielarc k,Edward&Adele Page 2 of 2 Property Owner(Print) P ry (Sign; Date 12-11-18 Representative:(Print) Jason Bhaian (Sign) J?— S*' Date 12-11-18 THIS AGREEMENT'S W MPOSED CF THIS PAGE AND THE REVERSE SHOE OF THIS PAGE AND SHALL BE CON510EREO THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED-hIS AGREEMENT IS BETWEEN Af.1ERICAN INS-ALw PONS,LLC HEREINAFTER REFERRED 10 AS'LCMPANY', ANCTHE CJSTOMERi51 NAMEC ABOVE.HEREINAFTER REFERRED 70 AS-UIENr.AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS.RE5UTATION5 AN ORCINANUS OF THE STATE OF MASSAUIUSET 15 09 CONNECT ICU-RESPECTIVELY,AS VVI AS Al LOCAL I0 RI501 L110145 The Commonwealth of Massachusetts I in Department of Industrial Accidents Office of Investigations wi 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 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 you an employer?Check the appropriate box: Type of project(required): I.FX1 I am a employer with 60 _ 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 ❑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 t0.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGI. I I.❑ Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.®Other Insulation comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new allidavit 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-iris. Liic.#: URWC610,9.917 Expiration Date: 09/04/2019 Job Site Address: / _ TSA_�1 1'� City/State/Zip: 'F , in&_ (31 t.'1` 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 a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 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 nat r : Date: Phone#: 413-55f-0200 Oficial use only. Do not write in this area,to be completed by city or town offrciaC 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 ®t Division of Professional Licensure Unrestrkted-Buildings of any use group which contain Board of Building Regulations and Standards less then 35,000 cubic feet(991 cubic meters)of enclosed Construction Supervisor spaces CS-106178 Upires:09/29/2019 WESLEY COUTURE a, - 218 LATHROP-STREET SOUTH HADLE`Y MA 01075 Failure to possess a current edition of the Massachusetts State Buckling Code Is cause for revocation of this license. For Information about this license Commissioner Call(617)727-3200 or visit www.mass.gov/dpl (t%/e ms jyi yyz yl �1Q�x a ni2Gfr.�:ux� ic: s a• 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 130 COLLEGE STREET SUITE 100 Expiration: 08/26/2018 SOUTH HADLEY,MA 01075 Update Address and return card. Mark reason for change. SCA 1 u 20M-05/11 11 A A1.'..—.-s �/�. �r:urrninrravr�/�ref^1r�aua��rrt1•�l: . � Office of Consumer Affairs&Business Regulation 4� HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. H found return to: i yd )'iQB,gistrstion 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 '� �_ 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Undersecretary valid without signature ACOROtn CERTIFICATE OF LIABILITY INSURANCE DATE PUMwrwaYYYis THIS CERTIFICATE 19 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 poNcy(les)must be endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this cartiAcste does not confer rights to the certificate holder In lieu of such endor s. PRODUCER Linda 1?0" rs Webber a Grinnell E (413)586-0111 FAXAC.Npi.(413)904-6401 8 north !Ging Street EIAIL al .lpoaeraftebberandgrinnell.co ADDRESS INSURERM AFFORDING COVERAGE MAIC 0 Northampton Kh 01060 INSURERA&VICYOrM ![muni Casualt INSURED uR RB:Berkshire Hathaway GUARD Ins. Co. American Installations, LLC BNSUNZRC: Attn L Now i Susanne Couture INSURER D• 130 College Street, Suite 100 INSURER 1: South Hadley NA 01075 COVERAGES CERTIFICATE NUMBER:Nester sxy 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. BNSR ADDL SUM im TYPE OF INSURANCE Policy Numm M&YE"M EX► LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A Z CLAIMS-MADE F�OCCUR S 300,000 5D3535217 9/4/2018 9/4/2019 MED EXp one won S 10,000 PERSONAL 6 ADV INJURY S 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY❑JEpCT E LOC PRODUCTS•COMP/OP AGO $ 2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLEUNIT $ 11000.000 A ANY AUTO BODILY INJURY(Per person) S AUTOSALLD X SCHEDULED 5X3535217 9/4/2018 9/4/2019 BODILY INJURY(Per aceldart) $ X HIRED AUTOS X MON-OWNED AUTOS PROPERTweldeY OAMAGE $ X CollS2,0W Z oomp$2,000 PIP•Bkst S 8,000 X UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAe CLAIMS-MADE AGGREGATE $ 1,000,000 ow I X I RmNnoNs io goo I 15J3535217 9/4/2018 9/4/2019 $ WORKERS COMPENSATION x ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNEPJEXECUTIVE ❑NIA E.L.EACH ACCIDENT $ 500,000 H OFFICEWMEMaH)EXCLUDED? 10 609917 9/4/2018 9/4/2019 (MMdelory in NH) E,L DISEASE•EA EMPLOYE S 500 000 If a d wnd, under E.L.DISEASE•POLICY UMIT S 500,000 A commercial vzwerty SA3535217 9/4/2018 9/4/2019 deduc0de$1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Sdndul%may be one~N mon spm*Is nquped) 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 W Grinnell, CPCU, CIC ��^~ rYZ � 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(20141101) The ACORD name and logo are registered marks of ACORD INS025(2ouo1)