21-017 (3) 469 SYLVESTER RD BP-2019-1035
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:21 -017 CITY OF NORTHAMPTON
Lov-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:INSULATION BUILDING PERMIT
Permit BP-2019-1035
Proiect# JS-2019-001692
Est.Cost:$3300.00
F 5.0PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Simian.ft.l: 376358.40 Owner: KOTEEN ELLEN L&D N PALLADINO
zonine: Annlrcant: AMERICAN INSTALLATIONS LLC
AT: 469 SYLVESTER RD
Applicant Address., Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON.•3121120190.00.00
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 321(20190:00:00 565.00
212 Main Street,Phone(413)587-1240,Fans; (413)587-1272
Louis Hasbrouck—Building Commissioner
l�AA 2 2�of ort mpton
i - � din De rtment
212 sin treat INSULATION
- � 01060
Phone 413-687-1240 Fax 413-587-1272 ONLY _
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION I-SITE INFORWTIM INSULATION PERMIT
1.1 PromirtyAddribur This section to be com/ppletedrb7y office
Map� Lot [ J / Unit
469 Sylvester Road
Florence,MA 01062 Zone Overlay District
Em SL District CB Mandel
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Koteen&Pallidino.Ellen &Diane 469 Sylvester Road Florence,MA 01062
Nemo(Prot) Cunad Ma11ng Address:
See attached (4131 584-8690
Teiephane
Signature
2.2 Authorized Aaent:
American Installations 130 College Street Ste. 100, South Hadley, MA 01075
Na\na p^"� Current Milling Addreae:
Y`lY1flYAw k (Citi a) � (413)552-0200
Signature Tebphone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Coat(Dollars)0 be Official Use Only
completed bpermit applicant
1. Building $3,300.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 8
3. Plumbing Building Permit Fee �o
4. Mechanical(HVAC)
8.Fire Protection
6. Total=(1.2+3*4.5) $3,300.00 Check Number
This Section For Official Use Only
Building Permit Number. Date
Issued:
Signature: ill 3-ZO-W 19
Building CommiasionernmpeGa of BWldng, Oaie
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. Not Applicable ❑
Hares Naof Ula
oense Noer IVeslev K. Couture 106178
Umme Number
130 College Street Ste. 100, South Hadley MA 01075 9/29/2019
1Mdress Expktlion Cate
1N4,ts.QLn (G . CLL\A1 ,(413)552-0200
Sgrsbea
Telephone
9.Rep6bhad Nmpe Improvement Contractor. Not Applicable ❑
American Installations 175982
Compare Name Registration Number
130 College Street Ste, 100,South Hadley MA 01075 6/26/2019
Address Egriration Date
Telephone (413)552-0200
SECTION 8-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.L.c.182,S 28C(8))
Workers Compensation Insurance aifidamt must be completed and submitted in this application.Failure to provide this affidavit will result
In Me denial of the issuance of Me building permit.
Signed Affidavit Attached Yes....... 1m No...... O
Brief Description of Proposed Work NOTE: INSULATION ONLY
Attic and basement insulation and air sealing throughout.
Koteen &Pallidino,Ellen &Diane/American Installations as Owner/Authorized
Agent hereby declare that the statements and Information on the foregoing application am two and aoounab,to the best of my knowledge
am belief.
Signed under the pairs and penalties of perlury.
Wesley K. Couture
Prim Name
3/16/2019
Sgnatured m Deb
1, Koteen&Pallidiri Ellen&Diane as Owner at the subject
property
hereby authorize American Installations
to act on my behalf,in all madam relative to work suMwized by this building permit application
\1 a.Zw V - ('C \A� 3/16/2019
Signature o� new
City of Northampton
Massachusetts
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AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
perforating work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair,modemization,conversion,
Improvement,removal,demolition,or construction of an addition to any preexisting ownerb cupied building containing
at least one bar not more than four dwelling units....or to structures which are adjacent to such residence a building"be
done by registered contractors.
Note.Ifthe homeowner has contracted with a corporation or LLC,that entity must be registered.
Type of Work: Insulation Est.Cost: $3.300.00
Address of Work: 469 Sylvester Road
Date of Permit Application: 3/16/2019
I hereby certify that:
Registration is not required for the following reasoo(s):
_Work excluded by law(explain):
—Job under 51,000.00
_Owner obtaining own permit(explain):
Building not owneroccupied
Otber(specify): Contractor pulling permit for homeowner
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury
I hereby apply fm a building permit as the agent of the owner:
4116/)110 American Installations 175982
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts rr
M ItainS O 80IYOIaa INSPHOTiOaa �, A
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Debris 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.
The debris from construction work being performed at:
469 Sylvester Road
(Please print house number and street name)
Is to be disposed of at
Waste Management of New England, Chicopee,MA 01020
(Please pant name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit Applicant or Owner Date
If,for any reason, the debris will not be disposed of as indicated,the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
M:n.a.,. a ■ ■ mass save
rya.rmtm ` PARTNER
ra 'ue,.arstxe American Installations warw.Amedcanlnfb6aaona-mm
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Customer Name:Ellen Hoteen
Email:Not provided
Phone:413-584-8690
Premia.Address;469 Sylvealsr Rd,Northampton,MA 01062
Melling Address:469 Sylvester Rd,Northampton,MA 01062
Proleot 10:3710703
Oats:Fab. 14,2019
Job Description
Measure Description Location Quantity Unit Total Cost Customer Cost
Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 10 hr $925.80 $0.00
Vapor Barrier-6 mil Polyethylene (with AS his) Living Space 264 SF $258.72 $0.00
Door Sweep(with AS hrs) _Living Space 3 each $75.93 _ $0.00
Exterior Door Weather Stripping(with AS hrs) Living Space 3 each $90.21 $0.00
Attic Stair Cover(with AS here) Living Space 1 each $251.69 $0.00
Damming Living Space 28 each $66.92 $16.73
Attic Floor-8"Open Blow Cellulose Living Space 896 SF $1,576.96 $394.24
Project Total $3,246.23
Weatherizaticn incentive ($1,232.91)
Pre-Weatherization barrier incentive ($250.00)
Air sealing incentive ($1,602.35)
Total Program Incentive -$3,085.26
Customer Total $160.97
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THIS AGREEMENT IS COMPOSED OF THIS PAGE AND ME REVERSE SIDE OF WIS PAGE AND SHALL BE CONSIDERED ME ENTRE AGREEMENT SY THE PARTIES INVOLVED, THIS
AGREEMENT IS Bf1WFFHNAFRKNIINSTALlA110Ni,LLC HEREINAFTER REFEMEDDOM K MPANY,ANOTHE CUSR3MERRU NARROW THE REVERY SIDE,HEREINAFTER
REFERRED TO AS'UIENF',RAW WILL BE SUBJECT TO ALL APPROPRIATE ROWS REGULATIONS ANO ORDINANCES OF ME STATE OF MASSOCHIIYTTS OR COINEC000T
RESPECTIVELY,AS WELL AS ALL OWN."GOIRIONS
ME FOLLOWING FUND AND CONOITONS AM APPLY
1. THIS AGREEMENT 155URRR TO ME APPROVAL OF A MANAGER OF ME COMPANY FOR MIS AGUE MEW TO BE EFFECTIVE UN DER ANY CIXipTION
3. SHOULD DE FAULT BE MADE IN THE PAYMENT OF THIS MOURNS FIT,CHARGES SHALL BE ADOE D FROM ME DATE THEREOF AT A KATE OF ONE AND ONE-HALF U-IA'
PERCENT PER MONTH.(18%PER ANNUM(WITH A MINIMUM CHARGE OF 5203 PFO MONTH,AND IF PLACED IN THE HANDS OF AN Arm EY OR COLLECT"AGENCY
FOR COLLECTION,ALL ATTORNEYS FEES,EXPENSES AND COSTS OF COLLECOON SHALL BE PAID BY THE HENT. INAODITJON,CLIENTUNUNN VXCSTMTIMFMLING
TO PAY MOORDING TO M E ABOVE TERMS,COMA RTY N AY HAW THE RIGHT TO A MN ON THE PROPERTY
3. THE COMPANY AGREESWATWXFM DELAYS BECOME KNOWN TO THECOMPAXY,MECOMPNNY WILLADMY MENEMA55L`OXATRFASONAME.
I. COMPANY AGREES THAT,NOTWITHSTANOING ANYAGREEMENT FOO MATERMLSANOOR LABOR Bf1WEEXCOMPAXY MD THIRD PARTY,COMPANY G RESPONSIBLE
TOCLIEXTFORC PLMMOPALLWIMKO RIBEDINATMEtYMDWpWMNLIUMANNER.
5. ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SUPPLIED BY THE COMPANY UNDER MIS AGREEMENT HWI BE MOR GIVEN BY ME MANUFACTURERS OF SUCH
EOUIPMEMAND PRODUCTS. UNDER SUCH AMHUFAC URER'S WARMMIES,ME WENT MAYBE REWIRED TO REGISTER OR MARL INA WARRANTY CARD OR OTHER
EVIDENCE OF OWNERSHIP AND USE Of SUCH EQUIPMENT ANGOR PRODUCTS IN ORDER TO ACNVATE SUCH WARRANTIES.
6. ME QUOTATION ON ME PAGE HEREOF WES NOT INCLUDE EXPENSES OR CHARGES EOR BOND OR IHSUMHCE PREMIUMS OR COSTS BEYOND NORMAL INSURANCE
COVERAGE,ANY SUCH ADDRIONAL EXPENSES,PREMIUMS OR COST SHALL BE ADDED TO ME TOTAL AGREEMENT AMOUNT.
J. THE COMPAIYS LMBIUTY FOR CLAIMS M61W WT OF THIS AGREEMENT SHALL NOT EXCEED ME TOTMAGREEMENT PRICE EXCEPT TO ME EXTENT THOSE MIRAGES
MEMOWNTOBESOEYDMTOMECOMPAWSNEGUGENCF.
B. WRING ME DUMMMIOFMEV RX ME NEMYIOMEO FMIWURAXCFWUSERE5PONNDUE A MDALLDAMAGESASLONGASTHE COMMNYHRS
TAKEN THE APPROPRIATE ACTION TO PROTECT MEAS OF WOR.
9. THECOMPANY IS NEXT RESO610LE FOR PREEXISTING DEFICHXIDES OR HA1AROpUS MATERIALS MAT MAN IFEST ME RISE LVE S DURING THE CONSTRUCTION PROCESS,
E G.W000 ROT,MOLD,ASBESTOS,NAIL POPS,DUCTWORK ANO CONNECTIONS,PW MBINGAND VENT%PE£DECKING DEFLECTION,UC IF APRE.EX141XG OEPCIE NO
OR NAIARWUS MATERIAL IS ENCOUNTERED PRICK TO OR DURING CONSTRUCTION,AND COMPANY IS NOTHED IN WRITINQ COMPANY WILL MY TO AMST CU ENT
WITHIN THE COMPAXI MEANS AND CAPABILITIES TO CORRECT THE PROBLEMS(ON A TIME AND MATERIAL WIS. HENT AGREES THAT SUCH CONDITIONS ART
UNAW IMBLE BY ME COMMNY AND SHALL JOT BE CONSIDERED A VIOLATION OFTHE AGREEMENT AND THAT WE M THESE CONDITIONS ME DURATION O THE
WORK AND SCHEDULED MR O COMPLETION MAY OFFER FROM MAT AGREED UPON,If APPUIGBLE,UNDER THIS AGREEMENT.
W. MECOMPMfI IS NOT RESPONSIBLE,AND ME CUENT AGREES TO TMD ME COMPANY HMMIESS,FOR ANY PROBLEMS AND/OR DAMAGES,INtWO1NG BUT NON
LIMITED TO MOO GROWTH.MILNG FROM ME PERFORMANCE OF MR SEALING WORK BY ME COMPANY AS A RESULT OF ANY KNOWN OR UNKNOWN NOKNRE
CONDITIONS.
11. ME COMPANY IS NOT RESPONSIBLEFOR,AND ME CLIENT AGREES TO HOLD ME COMPANY HARMLESS,FOR ANY PROBLEMS AND(OR DAMAGES RELATING TO ICE
DAMMING MAT M6Y ARSE DURING ARMOR AFTER THE PERFORMANCE OF WORT(BY THE COMPANY.
U. REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,ROOF JAGD,VENTILATORS,FLASHING,RAPERS,1095,INSULATION OR OTHER M ATERIALS ME NOT
INCLUDED UNLESS OTHERWISE NOTED HEREIN,
13. ME COMPANY WILL NOT BE RESPONSIBLE FOR THE SCRATCHING M DENTING O INTERIOR WALLS WHO CEII FLOORS,IMM,GUTTERS,DOWNSPOUTS,EXISTING
SNUG AND WINDOWS.OOME,Olt DRONEN IN DRIVEWAYS,NATURE FRACTURES IN CONCRETE OR BLACKTOP DONE AND WALKS,OR DAMAGE TO HANTS OR
SHNUBBERY.IF EXCESSIVE DAMAGE 15 MUSED BY COMPANY,COMPANY WILL REPAND REFLECT CHANGED ARMONLY AT COMMONS EXPENSE.
IA ME COMPANY UNDER PROVISONS OF CHAPTER MI OF ME GENERAL TAWS 5 REQUIRED TO APPLY FOR AND OBTAIN MLCONSMUICTIONAELATED PERMITS. THE
COMPANY SHALL JOT BE DEEMED RESPONSIBLE FOR DELAYS IN ME WORK DESCRIBED IN MK AGREEMENT CAUSED BY REGUUkMRY PERMIT GRANTING OR
INSPECTIONALAGENCIES,AUTHORITIES,OR INOIVIDUALS
15. THMAGREEMENT,INCLUDING THE PROVISIONS RELATING TO PNCE AND PAYMENTSCHEWLE,CANNOTBE CHANGED OR ALTERED EKCEPTBYAWMTTEN STATEMENT
SIGNED BY BOTH THE COMPANY AND THE CLIENT.
16. ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATON NOT WRITTEN D THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND HOT RELIED ON BY
EITHER PART,AND M NOT SURVIVE ME EXECUTION OF THIS AGREEMENT.
17, MIS AGREEMENT CANNOT RF CANCELED ARMOR ME MUTUAL WRITTEN CONSENT OF BOM PARTIES EXCEPT AS OTHERWISE SET FORM HERIN.
L. MIS AGREEMENT AND ANY WARMNMY PROVIDED HEREUNDER SHALLNOT BE ASSIGNED EXCEPTBY D WIN THE WRITTEN PERMISSION OF ME COMPANY
19. IF THE CLIENT TAUS TO PERFORM 05 OBLIGATIONS HEREUNDER OR TERMINATES MIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF ME COMPANY,THE
CLIENT SHALL BE LIABLE FOR DAMAGES FOR ME GRATER OF THE COMMMZKNAL DAMAGES SIX 1S%OF THE AGREEMENT FOR RFSOIXIM FEE.
E0. MY MANGES TO MATERIALS BY ME CLIENT(GRAND,STYLE,COLOR ETCJ AFTER SAID MATERIEL HAS BEEN DELIVERED OR 151N ROUTE TO THE CUENTCOULD RESULT
IN A 5%RE-STOCKING FEE WED ON ME COSTOF SKID MATERIALS.
il. MIS AGREEMENT SHALL BE EFFECTIVE ONLY LHON RS EXECUTION BY ALL PARTES TERM.PRIOR TO WHICH TGIF IT SHALL BE DEEMED A PROPOSAL.ME COMPANY
RESERVES THE RIGHT M REVOKE MI5 PROPOSAL 90 DAYS PROM DAR R IS REFUTED BY THE COMPANY IF U 15 NOT EARLIER EXECUTED BYTE UIENT MID THE
REQUIRED DOWN PAYMENT RECEIVED PRIOR TME EXPIRATION OF SUCH RD MY PERIOD,AFTER 9D DAYS,AND IN ME EVENT COMPANY WE5 NOT REVOKE THE
PROPOSAL COMPANY RESERVES THE RIGHT TO REVISE In PRICE IN ACCORDANCE WITH ITS COSTS IN EFFECT AT SUCH TIME
31. IF ANY PRWISON OF THIS AGREEMENT SHOULD RE HELD TO BE INVALID OR MENTIONABLE,ME VALIOITY MD MFORCENLITY OF ME REMNINING PRWSIOIS OF
THIS AGREEMENT SHALL NOT BE AFFECTED THEREBY.
33. ARBITRATION:IN ME EVENT ME CLIENT MD COMPANY HAVE A DISPUTE REDUCING ANY OF THE TERMS,CONDITIONS,PROVISIONS,OR PERFORMANCE OF THIS
AGREEMENT,THE PARTIES AGREE TO PLACE ME MATTER INTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION
ASSOCIATION TO RESOLVE TWIN DISPUTE,
N. ANY DISCOUNT PROMOTION REIMBURSEMENT,OR OTHER PACAGRAM THAT D PART W A STATE WAVERED UTILITY PROGRAM DE MASSSAVAIRSURECTMTHF
AVAILAOOTYOF WAURING STATE MONGERED PROGRAM AND WILL BE SUMECTTOMAMINATION ENE STATE SPOA REO UNITY PROGRAM IS OGCOUNTNUED.
FURTHERMORE.ME TENMSANDCWDRONSOFSTATE SPOISEPED UTLITPROGMMS MAYBE ALTERUFOR UPDATED PEMODICAILY WIN D WMIOUT NOTICE.
25. AMERICAN IXSTAIFRS,LLC 15 NOT AN AGENT OF ME UMM CONFIRM OF OWNER VERNON WORKING BY,THROUGH,OR UNDER ME MAKS SAVE'ENERGY
,PROGRAM.
36. HENT IS REPDXISIBLE EOR THE PAYMENT OF ANY AND ALL FEDERAL STATE,OR LOCAL TAKES MAT ARE APPLICABLE TO THIS AGREEMENT
The Commonwealth of Massaehusefts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
wuvi mfrs gov/dia
Workers'Compensalicn Insurance Affidavit: BUHders/Contraelor&MiwtricianstPlumbers
Applicant Information Please Print Legibly
Name(Ba.acas%0rgmialioNlrui viduo): American Installations,LLC
Address: 130 College Street,Suite 100
City/State/Zip: South Hadley,MA 01075 Phone#: 413-552-0200
An you an employer?Check the approp late box: Type of project(required):
1.9 lama employer with 60 4. ❑ I am a general contractor and 1 6. ❑New constmclion
employees(full and/or pan-lime).' have hired the sub-contractors
2.❑ 1 am a sole proprietor or purmer- listed on the attached sheet.r 7. ❑Remodeling
ship and have no employees These subcontractors have S. ❑ Demolition
working far me in anv capacity. workers'comp. insurance. 9, ❑Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its
required.] olBcers have exercised their ME]Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs in additions
myself(No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.]t employees.(No workers' U.®Other Insulation
comp.insurance required.)
*Am Wheant dal checks boo tl mea also rill not the scam.mints showmg heir wmken'wmpmsmion policy inromatio t,
t/lomeaw who submit lira affidavit indicating they ore doing all work and than him outside caotmmors must submit o iww unleash maintains such.
:C rectors Nat chock this box an ammhed an addition.sheet dmon.g no name or lM mh<.umcm a and thou wwkcn'romp.polo,infotmalion.
I am on employer that is providing workers'compensation busitrunce for my employees. Below is the policy and job site
htformation.
Insurance Company Name: Guard Insurance Companies
Policy a or Self-ins. �Liic.s: ( RWC609917 y� Expiration Doe: 09/04/2019
Job Site Address: N{z1 .�ta1 tl/f Sjrl ".I City/SntJLip: f ja&'qu
Attach a copy of the workers'lompcnsatioe 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 S 1,500.00 aMtur one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy ofthis statement maybe forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification.
i, hereby aenify under the pains a/nJd p inaldLes of perjury that the information provided above is true and correct.
Siune_ t_ uTh(J/�LA//Iml �L- l •.�1 /ZS>_- _ Date: I IG1
Phone M: 413-5510200
Oficial use only. Do an write in this area,to be compiled by city or town ofJ7claut
City or Town: Perink/Liceasc o
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City?own Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone a:
Commonweahh of Massachusetts Construction Supervisor
®� Division of Professional Licensure Unrestricted-Buildings of any use group which contain
Board of Building Regulations and Standards less than 36,000 cubic feet(""Cul meters)of enclosed
ConstruGibn Supervisor space.
CS-106178 E;pires:Og/2912019
WESLEYCOUTURE -
218 LATHROPSTREET u
SOUTH HADLEY MA 01076
Failure it possess icurtest editionofthe of
hcense
Stile Building Cade is cause for t this Itlon of This license.
Far 7V42ation about this license
Commissioner � Call(617)T2Td200 or visit www.nuss.govldpl
: +-7Office 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: Ofi/26/2019
SOUTH HADLEY,MA 01075
UpdaM Adaraaa and Wurn and. Mirk reason for change.
Addle. n?=�1 F!Employment O Lost Card
Office of Consumer Allain a Business Repulmon
HOM E IM PROVEM ENT CONTRACTOR Registration valid for individual use only
TYPE:LLC before We expiration data. H found return to:
Raolctrdlon FilmnatIgD Office of Consumer Affairs and Business Regulation
176882 Ci 10 Park Plaea-Suits 61M
AMERICAN INSTALLATIONS,LLC. Boston,MA 02116
WESLEY COUTURE
130 COLLEGE STREET SUITE 100
SOUTH HADLEY,MA 01o7s Undermsecretary ei valid without signature
AC"ROa CERTIFICATE OF LIABILITY INSURANCE 914/2018
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: It the certificate holder IN an ADDITIONAL INSURED,the policy(Ms)mgt M andonetl. H SUBROGATION IS WAIVED,subject W
thetams and conditions of the polity,Certain policies may re0ulre an erworsemMA AMa wton Mis Certificate Coesnotcdnfxdgh to"
cortlficea holder In Ileo Of..on endomemen0 a.
MOOAtER Lin" F.E.
Sfabbor 6 Gri1me11 u. (613)586-0111 Mvmo-un
I Mortb King Street AMBERS•1Powars6MebbrBdgri113all.com
IN MRP IAOIONOCOVEMGe F
BrtbaapCop MA 01060 MURERA: 1 ra Mutual Cesuelt
MURERe:Barinllire Hatlasway tM5 Ins. Co
Arri0an Installati., LLC MURERc:
Attns RON a Wsaana Couture
110 College atrest, shun. 106 INSURERE:
South RadlaV MA 01075 MURERF:
COVERAGES CERTIFICATE NUMBER:Master Mum 9-5019 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NMIED ABOVE FOR THE PJUICY'PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF My CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY SE ISSUED OR MAY PERTAN.ME INSIR VOICE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND COIDITIONSOF SUCH PoLICIES.UNITS SHOWN May HAVE SEEN REDUCED BY PAID CLAIMS.
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OMSL,yy®A16gIaVL1ay�r AFFUg aMt oEr6yy AG01®ATE 5 21000.000
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