44-068 1005 FLORENCE RD BP-2019-0905
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map:Block:44-068 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 ft BP-2019-0905
Project# JS-2019-001509
Est.Cost- $3300.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groum AMERICAN INSTALLATIONS LLC 106178
Lot Size(sa. 11.): 12022.56 Owner: MUSANTE WILLIAM I&MAUREEN P
Zoning, Aoplicant: AMERICAN INSTALLATIONS LLC
AT: 1005 FLORENCE RD
ApolicantAddress: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON.2/19120190:00.00
TO PERFORM THE FOLLOWING WORK.ATTIC 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: 01: 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 sienature:
FeeType: Date Paid: Amount:
Building 2/19/2019 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use dfily
City of Northampton Status of Permit
Building Department Curb CubDdvaway Permit
212 Main Street sevrenseWcavallabniry
Room 100 Water(Weti Avanabtiity
Northampton, MA 01060 Tea SetsofstruiWml[Plans
phone 413587-1240 Fax 413587-1272 PIot/Site Plans
OtherSperdry
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I-SITE INFORWM 6/✓-, l q - �G norty
1.1 Property Address: ThI section to be completed by ce
1005 Florence Road Map �/ Lot—Unh.
Florence,MA 01062 Zone Oveday District
Elm St.District. CS Distrlet
SECTION 2-PROPERTY OWNERSHIPIAUTHORD:EDgGENT
2.1 Owner of Record:
Maureen &William Mustante 1005 Florence Road, Florence
Name(Pdnt) Orperd Mem Address:
(413) 58 4446
See attached Telephone
SigmWm
22 Authorized Agent:
American Installations 130 College St., Ste 100 South Hadley, MA 01075
Nemo(PM) Curtest Manby A4Meas:
413-552-0200
Sgnetae - T�bphone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permitapplicant
1. Building $3,300.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction frau
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fye Protection
6. Total=(1+2+3+4+5) 53,300.00 Check Number x7!
This Section For lMiclal Use Only
Date
Building Permit Nu bei. Issued:
Signature: 2-Iq-2O)q
Building Comm eslonemmpector of Buldbgs Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable1
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs DZ31 Decks M Siding" Other[A
Brief Description of Proposed
Work_Attic insulation and air sealing throughout
Alteration ofewsting bedmom_Yes_No Adding new bedroom Yes _No
Attached Narrative Renovating unfinished basement as No
Plans Attached Roll -Sheet
ga.if New house and or addition to existing housing complete the following:
a. Use of bugding:One Famly Twc Family Other
b. Number of rooms in each(amity unit: Number of Bathrooms
c. Is theta a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
I. Method of heating? Fireplaces or Weodstmes Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of wnsWction
I. Is mnstruc0on wid in 100 R of wegands?_Yw No. Is construclim witlnin t00 yr. floodplain Yes No
j. Depth ofbawmenl or cellar floor below finished grade
k. W01 building conform to the Building and Zoning regulations? Yes_No.
I. Septic Tank_ City Sewer_ Prkateweti_ Citywater Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Musante,Maureen &William as Omerofthesubject
property
hereby authorize American Installations
to act on my behalf,in of matters relative tl w authorized by this building pemtil application.
See attarhed 2/11/2019
Signature of Owner Date
I, American Installations as Owner/Awhorzed
Agent hereby declare that the statements and information on the foregoing application are true and accurate,fa the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
American Installations
Print Name
W11� �- Izljza_u 2/11/2019
Signature of Agem Data
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: 1005 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
2/11/2019 QR)'Ql„ k, (a�WXo
Date Signature of Permit Applicant
mass s�
• save
.,m:eas nwrea PARTNER
ma s s ia:r=a
ma aeprrtmomansry American Installations wwwAmericanlnetallations.com
vn[uxeaeso-en Swte vW.swu waq,mn puns.oRrr aysl ssz.oxW rva:luai Six.oxnx.[m.A woe.,r@>pme,ammauu.mn.
Customer Name:William Musante
Email:Not provided
Phone:413-5844446
Premise Address:1005 Florence Rd,Northampton,MA 01062
Project ID:3687287
Date: Feb. 5, 2019
Job Description
Mesarµr O Scyptlan Lp=tkm Clussil anit yiad too customer Cost
Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 10 hr $925.80 $0.00
Door Sweep(with AS hrs) Living Space 2 each $50.62 $0.00
Exterior Door Weather Stripping (with AS his) Living Space 2 each $60.14 $0.00
Door- 2"Thermal Barrier Polyiso Living Space 1 each $90.44 $22.61
Attic Floor - 7'Open Blow Cellulose Living Space 988 SF $1,659.84 $414.96
Bath Fan - Vent to Soffit Living Space 1 each $137.71 $34.43
Propavent Living Space 60 each $249.60 $62.40
Damming 32 each $76.48 $19.12
Project Total $3,250.63
Weatherization Incentive ($1,660.55)
Air sealing incentive ($1,036.56)
Total Program Incentive -$2,697.11
Customer Total $553.52
wFaMMC Nneaoa onalarom,l.eAd'emnae ue aeow Hrtea panerwnb nor a Lrea ambrerouldfarumr.
Marlen n alarm, _D PI Par oposs:romrnfi al mapml and lffim to[replete the adore scene rrwp,A lr aa[ormnae Arth:he aewe ap¢Sbm o,ded a dAI and one
h:lara"arlaarn,rorue rtal(sVa Ton—a,mtee M,eln
AvIIII.II .- Troid.-: The e— Anke, sLeGtinrrn, add mn1 are T.ILC lar."Inme r( XX
wraaew.ane arenern..,adea.orareawnrrueeto aowra.a„cennea.=+.m.nr sawn P,v �p 2-a-2^019
As re u9 arum Panrtn,tan wwk,mdedunreau.uvnn cwndearn. ^.'n<=
0
9alan[e Une UPI'CnmPltlbn= S
20192-5
SpMure
Muse¢,William and Ma neo, Page 1 of 1
Arpvty Ownv 1"..” IIdd
5-2019
amresmnmeaaanel GDngpvkh fsanl —Done 2
CN The Commanweatth of Massachusetts
Deportment of Industrial Accidents
Office of investigations
600 Washington Street
Boston,MA 02111
wi cow v.reass.govIdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EleetriciansfPlumbers
Applicant Information Piease Print Leftiblr
Name(Boniness+caganiranerviodoid,wq: American installations,LLC
Address: 130 College Street,Suite 100
City/State/Zip: South Hadley, IYIA 01075__ Phone k: 413-552-0200
Are you an employer?Check the appropriate box: Type of project(required):
LO] i am o employer with 60 4. ❑ 1 am a general contractor and 1 6. [1New construction
employees(full andlor peo4ime).* have hired the sub-commctors
2.❑ I a sole proprietor partner-
listed on the attached sheet.t 7- E] Remodeling
shipip and have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity. workers'comp. insurance. 9. ❑ Building addition
[No workers'comp.insurance, 5. ❑ We are a corterahon and its
required]
officers have exercised their
a 10'❑Electrical napalm or additions
3-❑ 1 am a homeowner doing all work right of exemption per MGL 11,0 Plumbing repaim or additions
myself,iNo workere'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required,I t employees. Mo workers' I3.®Other Insulation
comp,insurance required.]
*Any npplirenl IMI cheeks box 4 marl oleo fill omahc sxtien blow showing thew workers'mmpmzetion polity msennaion.
t 1lemcownera who win,t she offd vx moaning ox,an doing dl work and nim biro OMW'eonexays mmi submit a n-4sv zlydmit indiodwlt sash.
:Commctors mot cw:ck this boxe et uuchedanedditronxi ahmtshnwmg les nev, w na,su nuugas and sMh wahe,s'camp.policy infpanaaoo.
I am an employer that it providing"there,compeuwtins,imonew.'e for my employees. Below N the palicy and job sire
injorrrmrfan.
Insurance Company Name: Guard Insurance Companies
policy q or Self-ins. Lf�6.b
ii�e,yei UR�W' C609917 � Expiration Date: 09/04/2019 /
Jobsim Address: Jj_J1 � NJoq 3t°d„-04VA city/statel7,ip:—E[/^r`u t4u � btbt L
Attach a copy of the workers'eompensafiaa 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$1,540.00 andlor one-year imprisonment,in;well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy ofthis statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification,
l ao hereby cenlfy ander the pains atnn�Id penallies oft,ainry thin the information provldedabove iss lloss and correct
pb e,a (/ 413 200
[G.ry
ficial use only. Do not write in this area,to be com ploed by city or town official
or Town: PermitrLtcecese a
tting Authority(circle one):
Board of Health 2. Building Department 3.Cityrfown Clerk C Electrical Inspector 5. Plumbing Inspector
Other
ntact Person: Phone a:
Cormnnanearor of Massachusetts C°aebudion Supervisor
®; Division of Professional Licensure Unrestricted-Buildings ofarry use,group attach contain
Board of Building Regulations and Standards less than 96,000 cubic feet het cable meters)oferitlosed
Construction Supervisor Se-
CS-106178 Egpires:09/29/2019
WESLEY COUTURE -
219LATHROFI$TREET. t�
SOUTH HADLEYMA 01876
I.Mura W possess o cu... OMM olere Mmuchusells
Site Building Code Is cause,for revocoUM of thM Bosses.
For IresmMUM about fits license
Commissioner Call(617)7n4200 or viae wwwmas.9otmp
��� a�yrrraafrraefr�lf 'C�/�rx f 1n
h
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: LLC
175982
AMERICAN INSTALLATIONS,LLC. Rrlgdtration612SI
130 COLLEGE STREET SUITE 100 EgExpiration:: 0 08/26/2018
SOUTH HADLEY,MA 01075
Update Address and rsiwn said. Mark reason for damage.
acAi a ..11
n Add-- n Q..�....r LI.Em_n_imttr,am r1 met Cqp
% Y:rourmnro..r//ti r�'J�auv/aha/A
.'� Min of Co mwA in 6 Business Rpuhdon
^ HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE:LLC fusion Me w0radon data. M bund realm lo:
6agialu ial E2&IfHtl9U Office of C...Alfalrs and Business Regulation
175M 06/26=19 10Park Hasa-Suhes170
AMERICAN INSTALLATIONS,U.C. Beeteq MA 02116
WESLEY COUTURE
130 COI LEOE STREET SUITE 100
SOUTH HADLEY,MA 01075 Undersecretary tvalid without Signature
ACCP d CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE VOIDER.THS
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 MIRIAM INSURER(S), AUTHORIM
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: N tm eonff s holds Is an ADDITIONAL INSURED,the poky(m)Inwa be endorsed. N SUBROGATION E WAIVED,eu Jw W
the toms and muffI ars of ON,pollex,when polkbe my require an andonanant Awl w this canniness dm not.ones d"to the
WINNER,heklor In lieu of own wxWomainga.
pNOINKIl llnm EORers
Nabber F Gsismil D ({13)586-0111 pA'I uah.0-ran
e Roreh ting street "A 1posersMrebberesdgrimell.cam
INRIN ARORYMO COnRRW XaICr
N hatRptm IIA 01060 NWREIhA 1 m Matml Casualty
tlaDR® warmrasH kabim RRI GUARD lm. Co.
A ica,n lvetaliatiooe, N.0 NWmc;
Atm. Me. A firm. CO t. N p:
130 College Gtr t, Suite 100 W8 Rene;
South Radley Eq OSOTS
COVERAGES CE"ROATENUMBER:M.ter yaw 9-2019 REVISION NUMBER:
THIS IS TO CERA%THAT THE POUgES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN"ED WIRED ABOVE FOR THE P CY PERM
INDICATED. NOTWRHSTANgNO ANY AEOUIREMENT,TERM OR CONq OF ANY CON RI OR OTHER DOCUMENT WITH RESPECT TO WHICH MIS
CERTIFICATE MAY BE ISSUED OR MY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH FC JCIES.UNITS SHK ANN MAY HAVE BEEN REgaCED BY PAID q IMS.
LMR ryMOfYWMNCe Lam
CMIIRiNGAL OIFiN1L.LIN ! 1,000,000
A z CUIN6wpE ❑OCLIq s 300,000
].]535.11 9/41201. 1/0/4019 M®EM a 10,000
PB10g111lAW RUURV t 11000.000
OEMLA('bREOMEIIIR ARLEl FFfl: pF1FA/.LA(gRHJATE ! ]r 000,000
X A.ULV❑JEer-F ❑Ip. PNIOYLS.WMP.CP AW F ].000,000
$
Aphawahsweum s 11000,000
A ANY AI BMLYINWR 0N,~ !
A. S, z ADVD snnliv 9/412019 11112019 P YINWRY(Pw cNnp f
X MRm AVFG9 X AVINJNLMm MJPGrtY D— F
2 Ctll iim Z wnpa... pp f 8,000
Z VMRYIA Ws — EIGHO=SRME f 1,000,000
A nD®� LWMSWOE AIXAf,ATE f 11000,000
Z ]S]9]]2l1 9/a/i039 ./112019
WOrViMCdrHYA1gN a
w.artoreM•tIARUT r/x
NfI VRYNEig4PMINEMFEdITVE E.L MLMACCICQIF f 600 000
R CFFWFRMpA9Fq E%CLVDEM ❑N/A
pYn1MyM 100 .NNC809911 9/a/2019 9/411019 EL G9FAlEa 300 000
tl iMWn
A C."1 PCOperty !41!]]]11 9/9/]01. 911/]019 MUCbl;RO
MMMFIMNI Of OPlRAT0101 LOCAl101LL/YO1Yl8 IACORD tN.b.Yevl N.n�Y LiaOM,my M.YeM a nm rp.0 N,pitll
CERTIFICATE HOLDER CANCELLATION
BNOU W ANY OFTHE ABOVE IKBCRBED POLICIES BE CANCELLED BEFORE
wide.. of IGaerame THE EXPRATION RATE THEREOF, WMCE WILL BE OEUVERED IN
ACCgmANCE WITH THE P XKN PROVISIONS.
wnroNQ®R[PRnfNFAME
W Grinnell, CPM, CIC �✓-�l �� � �
0/9884!DI4 ACORD CORPORATION. All Halm reserved.
ACORD 25(2014101) The ACORD maw end logo are reglMxed marks of ACORD
IN802SIZOIaU