37-008 (4) 770 FLORENCE RD BP-2019-0860
GIs#: COMMONWEALTH OF MASSACHUSETTS
M"Block: 37-008 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-2019-0860
Project# JS-2019-001430
Est. Cost: $6605.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sg. ft.): 71874.00 Owner: MERLE ALEV
zoninz Applicant. AMERICAN INSTALLATIONS LLC
AT. 770 FLORENCE RD
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON.21512019 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:
FeeTyne: Date Paid: Amount:_
Building 2/5/2019 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
_1V s Cl6/1" 7 lr
1 Qepartment use'oN
C of Northampton Status of P,ermit._
B ilding Department Curb Crrt/Dnveway Permit
=- 4 12 Main Street Sewer/SepttC•Availabilily
Room 100 Water/VN611Availabili
F�TOFGING INSPr-CTIONOrt ampton, MA 01060 Two Sets of Structural Plans
NORI F,-v�. TON, h�� 7-1240 Fax 413-587-1272 P.lot/Site Plans. . . .
Other':Specify-.
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 47(/'—t q- 90
1.1 Property Address:
This section#o be completedb office
Map Lot 00 Unit.
770 Florence Road
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2A Owner of Record:
Merle Aleft 770 Florence Road
Name(Print) CUITa'pt
See attached Telephone
Signature
2.2 Authorized Agent:
American Installations 130 College St., Ste 100 South Hadley, MA 01075
Name(Print) Current Mailing Address:
413-552-0200
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermk applicant
1. Building 6605.00 (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) '' Check Number dim
This Section For Official Use Only
Building Permit Num er. Date
Issued:
, 11-?
Signature: 7 Z—41-ZD 19
Bulding Commissioner/Inspector of Buildings Date
w
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 M--- ——�
Setbacks Front C�
Side , L:= R:= L:= R:=
Rear !�
Building Height
Bldg.Square Footage % -�
Open Space Footage % �----
(L.ot area minus bldg&paved
parking)
#of Parking Spaces I J
Fill: - -------; --------------
volume&Location) IF
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW Q YES O
IF YES, date issued:,
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book L Page�� and/or Document#!
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES a
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES,describe size,type and location: 1
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 0 NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
R
SECTION 5-DESCRIPTION OE PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[p Siding[E3] Other[&
Brief Description of proposed
Work: Attic and basement insulation and air sealing throughout
Alteration of ebsting bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.1 New house and*or Addition to existinwhousing-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, 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
Signature of Owner Date 1/23/2019
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
Signature of r/Agent Date 1/23/2019
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Superylsor: Not Applicable ❑
Name of Ucense Holder: Wesley K. Couture 106178
License Number
130 College St., Ste 100 South Hadley, MA 01075 9/29/19
Address Expiration Date
�gLxA �• 413-552-0200
Signature Telephone
9.Registered Hoene Jmprovemerit Contracfori 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....... 0 No...... ❑
11. _Home Owner';Egemption
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 10835.1.
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 iperson 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 hnffch
Lng Hermit.
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 see attached
R
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: 770 Florence 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
Date Signature of Permit Applicant
t
City of Northampton
��._ S�5'•-.w. SSC
Massachusetts
DEPARTMNT OF BUILDING INSPECTIONS y`•;
212 Main Street • Municipal Building
Northampton, MA 01060 8f7�
Property Address: 770 Florence Road
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property Owner
Name: Merle Alev
Address: 770 Florence Road
City, State: Northampton, MA 01062
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 k
Date
1/23/2019
mass save
Licensed&Insured PARTNER
MA Cit Jr.-106178
MA Registration 111 275582 American Installations www.Americaninstallations.com
130 College Street Suite 100,South Hadley,MA 01075*Office:14231552-0200 fan:(413)552-0202• EmaiL,support@Americaninstaltafions.com
Customer Name:Merle Alve
Email:Not provided
Phone:413-570-4833
Premise Address:770 Florence Rd,Northampton,MA 01062
Project ID:3654486
Date:Jan.23,2019
Job Description
[Me*"
et-Cost
Description - ILlobaff, C
Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 18 hr $1,666.44 $0.00
Exterior Door Weather Stripping (with AS hrs) Living Space 3 each $90.21 $0.00
Door Sweep(with AS hrs) Living Space 3 each $75.93 $0.00
Attic Floor-8"Open Blow Cellulose Living Space 2080 SF $3,660.80 $915.21
Damming Living Space 98 each $234.22 $58.55
Propavent Living Space 120 each $499.20 $124.80
Bath Fan- Vent to Roof Living Space 1 each $141.30 $35.32
Line Voltage Electric Thermostat Aube Living Space 2 each $236.00 $0.00
Project Total $6,604.10
Weatherization incentive ($3,401.64)
Electric Thermostats and Exhaust Fans (
incentive $236.00)
Pre-Weatherization barrier incentive ($0.01)
Air sealing incentive ($1,832.58)
Total Program Incentive -$5,470.23
Customer Total $1,133.87
WARRANTY:American Installations.LLC will provide the above stated homeowner with a L-year workmanship warranty.
American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state
building regulations for the Total Contract Value as stated herein.
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRAC-,VALUE=S 1,133.87
satisfactory and are hereby accepted.You are a uthofized to do work as specified.Payment Down Payment=S IM217
will be 1/3 down prior to start of work,and balance due upon Completion. PAID
Balance Due Upon Completion= 5 MUR 916.87
Signature Date 1/23/2019
Page I of 1
Property Owner(Print) _(Sign) Date
Representative:(Print) Garrett Demers (Sign) Garrett Dem Date1/23/2019
1h1%AUKEEIAtSIT IS WIVIPOSED VF TMS PAGE AND I i-EREVERSE 5 CC CP IHS PAGE ANO"All.EE CONSIDEREJ TMS 6.4114EAGAVEIVEN1 V 1HE—TU INIVOWED 7 HIS AGREEMEN7 IS BVWEEN AMEMcAh'%I-.�LAYIDNS,LLC 10 AL XDKV�41',
ANC1HE AIM,0SE11001IR REFERRED TO AS'QIINf*.AND Witt BE SUgIECT TO AM APPRC-14LAW i,RE3US,iO1SAND O4OINA QES OF WE SlAAEOf iAASP0,U$t715 CA CCNNEC1ICX R(!,MT;V%Lv.As'NEU AS All LUCAUVRODISIM
The Commonwealth of Massachusetts
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 Lezibly
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):
1.9 1 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 E]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 ME]Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 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'
comp. insurance required.] 13.®Other Insulation
*Any applicant that checks box#1 must also rill out the section below showing their workers'compensation policy information.
t I lomeowners who submit this aftodavit indicating they arc doing all work and then hire outside contractors must submit a new atridavit 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.
1 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.#: URWp�C6�099917 Expiration Date: 09/04/20�19� , f`
Job Site Address:_ M FIO�I,F�Ll-l.� QG� City/State/Zip: o Il 11,y)I�Mh NOW-
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.
1 do hereby certify under the pains and penalties of perjury that the information provid d aboveistrue and correct.
i a Date:
Phone#: 413-551-0200
Oficial 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#:
f Commonwealthf Massachusetts Construction Supervisor
Division of Professional Licensure Unrestricted-Buildings of any use group which contain
Board of Building Regulations and Standards less than 35,000 cubic feet(981 cubic meters)of enclosed
Construction SLIpervisor space.
CS-106178 Expires:09/29/2019
WESLEY COUTURE m
218 LATHROP''sMET i
SOUTH HADLEY-.MA 01076
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)7273200 or visit wwwAwss.gov/dpl
1 n�ll,na jyt yyl1� l �1rzfy�/ r� ni2 ,l�cxi2/u:�e1 .I
` 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 F�cpiration: 06/26/2019
SOUTH HADLEY,MA 01075
Update Address and return card. Mark reason for change.
SCA 1 A 2OM-05/11 11 A Lm—esc 0 rl_RrnTQYmen_0 est rL rd
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
J TYPE:LLC before the wcplration date. K found return to:
si r irabon Office of Consumer Affairs and Business Regulation
\. ` .; iv
,r 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 01075Undersecretary^ valid without signature
AC RL7�' DATE(MI D°"'M
CERTIFICATE OF LIABILITY INSURANCE 9i*i2018
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 pollcy(les)must be endorsed. B SUBROGATION IS WANED,subject 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 endorse e.
PRODUCER cmoAmNTfCT Linda Powers
Webber 4 Grinnell Mr.E. (413)586-0111 1 FAX ca13)se4-sass
8 North King StreetRLADORMS-lyowersirwebbsraudgrinnell.com
INSII AFFORDING COVERAGE NAIL I
Northanglton 11A 01060 INSURER": 1 rs Mutual Casualt
INSURED ERS:Berkshire Hathaway GOARD Ins. Co.
American Installations, LLC INBURERC:
Attn: Wes & Susanne Couture INSURERD:
130 College Street, Snits 100 INSRER1:
South Hadley 1111 01075 INS MRF.
COVERAGES CERTIFICATE NUMBER-Maxter sxn 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.
ILTR NSR ADM OLMM
TYPE OF INSURANCE POLICY NUMM 02O&M
Y EYWYYI LAST$
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE ro-mxrm—
A X CLAIMS-MADE 7 OCCUR S 500,000
SD3535217 9/4/2018 9/4/2019 MEDEv pe Remo $ 10,000
PERSONAL&ADV INJURY S 1,000,000
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY❑JPEPCOT F�LOC PRODUCTS-OOMP/OPAGO $ 2,000,000
OTHER: I I $
AUTOMOBILE uA81LITY COMBINED SINGLEUMrr $ 11000.000
ANY AUTO BODILY INJURY(Per Person) S
A ALL OWNED SCHEDULED
AUTOS X AUTOS SE3335217 9/4/2018 9/4/2019 BODILY INJURY(PeracddsM) S
&
X HIRED AUTOS X AUTOS PROPERTY DAMAGE
x Coll 52,000 X oompv0w PIP-Beslo $ 8,000
X UMBRELLA UABHCLAIAS-MADE
OCCUR EACH OCCURRENCE $ 1,000,000
A EXCE88 LIAB AGGREGATE $ 1,000,000
DIED I X I FiETENnoNs io.000 5a3335217 9/4/3018 9/4/2019 $
WORKERS COMPENSATION g
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE Q N/A E.L.EACH ACCIDENT & 500,000.
8 OFFICEPJMEM ER EXCLUDED?
IMMwnbry InNH) ORNc609917 9/4/2018 9/4/2019 E.L.DISEASE-EA EMPLOYE S 500,000
if tleamdbe antler
A E.L DISEASE-POLICY LIMIT 1$ 500,000
A Commercial Property SA3535217 9/4/2018 9/4/1019 deduftle$1,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Addltoml Renwft 9006ule,nny be sm ad"N mae epeae N requlnd)
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
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025(2ouo1)