25A-041 (4) 26 MARSHALL ST BP-2019.1301
GIS#, COMMONWEALTH OF MASSACHUSETTS
MapJBiock:25A.041 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateaon- INSULATION BUILDING PERMIT
Permit a BP-2019-1301
Proiect# JS-2019-002099
Est Cost $2700,00
Fge:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const Class Contractor: License:
Use Groum AMERICAN INSTALLATIONS LLC 1 617
Lot Size(so.ft.): 10193.04 QWner: PASCUCCI DAVID E&WANNE MACK
zoning_URB000)! Analicant:AMERICAN INSTALLATIONS LLC
AT: 26 MARSHALL ST
ADnlicantAddress: Phone: Insurance:
130 COLLEGE ST (413)55.)-0200 WC
SOUTH HADLEYMA01075 ISSUEDON:S/17/, 0190:00:00
TOPERFORM THE FOLLOWING WORK:ATTIC AND KNEEWALL INSULATIN &AIR
SEALING THROUGHOUT
POST THIS CA" SO IT IS VISIBLE FR,CQM THESTRELI
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 eaertme It Fireplact/chimuoy:
Rough: Insulation:
Final: 6moke; Final:
THIS PERMIT MAY BE REVOKED BY THE CITY"OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
geciflcalig of Q02w angy Signature:
FeeLnat Date Paid: Aenougt:
Building 5117/20190:00:00 563.00
212 Main Suvoi,Phone(413)587-1240,Fax;(413)587.1272
Louis Hasbrouck—Building Commissioner
City of NortIS pton R_ECEI EC7
�> - '" Building Depart ent v
t 212 Main I et / U/ � '�`���I.
a �( t Room 10 MAY 1 5 (9
Northampton, 01 0
�� phone 413-587-1240 Fa 41 ONLY ar r-urc r,iq m cFgtioNs L
N013 11
APPLICATION FOR INSULATION FORA ONE OR TWO FAMILY DWELLING ONLY
SECTION I-SITE INFORMATION INSULATION PERMIT
1.1 Property Address: This section to be completed by office
Map a57114Lot 6y� Unit
26 Marshall Street
Northampton,MA 01060 Zone Overlay District
Elm SL Disbicl CB Diablo
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
21 Owner of Record:
Mackler&Pascucci, Dianne & David 26 Marshall Street Northampton MA 01060
Name(Print) CuneM Mailing Address:
See attachedf4141594-9454
Telephone
Signature
2.2 Authorized Agent
American Installations 130 College Street Ste, 100 South Hadley MA 01075
Ma e(Print) Cuirent Mailing Address'.
,gTk.c„t L � � (413)552-0200
Signature " Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permitapplicant
1. Building $2,700.00 (a)Building Pemit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
<
4. Mechanical(HVAC)
5.Fire Protection
B. TOW]=(1 +2+3+4+5) $2.700.00 Check Number 3
This Section For Official Use On
Date
Building Permit Num Issued'
Signature: 5-r7
-?Olq
Building Canmesioneranspector of Buildings Date
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4.CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor; Not Applicable ❑
Name oruronee Holger: WesleyK. Couture 106178
License Number
130 College Street SI e. 100, South Hadley MA 01075 9/29/2019
Atltlress apeation Date
(413)552-0200
$gnalure Telephone
S.Registered Home Improvement Contractor: Not Applicable ❑
American Installations 175982
Comparry Name Registration Number
130 College Street Ste. 100, South Hadley MA 01075 612612019
Address Expiration Date
Telephone (413) 552-0200
SECTION 5-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8))
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....... .V No...... ❑
Brief Description of Proposed Work NOTE: INSULATION ONLY
Attic and kneewall insulation and air sealing throughout.
I, Wesley K. Couture - American Installations as Owner/Authorized
Agent hereby declare that the statements and information an the foregoing application are We and accurate,to the best of my knowledge
and belle(.
Signed under the pains and penalties of perjury.
Wesley K. Couture
Print Name /�'+ —'
uykt.1 V-. V-�.uy-u. 5/11/2019
Signature of er/Agent Date
I, Mackler &Pascucci, Dianne &David as Owner of me subject
property
hereby authorize American Installations
to act on my behalf,in all matters relative to work aumonzed by this building permit application.
5/I1/2n19
Signature of Owner Date
City of Northampton
�
Massachusetts
(" Y
( l89AItr1RNT OF BPILBING IBSPE(:TZOBE p e
212 Hein S[rot • Mnieipel Builai�
Nor[hempton, mi 01060 \e
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. Prim to
performing work on such homes,a contractor most be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation,repair,modernization,conversion,
improvement,removal, demolition, or construction of an addition to any pre-existing owneroccupled building containing
at/east one but not more than/our dwelling units....or to structures which are adjacent to such residence or building'be
done by re 's ered contractors.
Note:Ifthe homeowner has contracted with a corporation or LLC,that entry must be registered
Type of Work: Insulation Est.Cost: %2,70000
Address of Wmk: 26 Marshali Street
Date of Permit Application: 51 t 1/2019
1 hereby certify that
Registration is not required fm the following reason(s):
_Weak excluded by law(explain):
_Job under S I,OKOO
_Owner obtaining own permit(explain):
Building not owner-occupied
x Other(specify): Contractor pulling nermit 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 for a building permit as the agent of the owner:
5/11/2019 American Installations 175982
Dale 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
t "4 1OF BING INap$OTIONS
212 Ma GILD
213 painnSCzwt •ppBitipal Bulltling JL��\2� 'C
Nar[Famptea, pB 01060
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:
26 Marsha]]Street
(Please print house number and street name)
Is to be disposed of at:
Waste Managementof New England, Chicopee, MA 01020
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
11 (Company Name and Address)
Signature&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.
City of Northampton
/ Massachusetts � �r
1 .
n212 Min S r eaaILUZNC zxsrccring '
zaz Main r=; . xunieiwz Building
M.�n,.�con, em aioso
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: 26 Marshall Street
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley MA
Phone: (413) 552-0200
Property Owner
Name: Mackler&Pascucci, Dianne&David
Address: 26 Marshall Street
City, State: Northampton,MA
1, Wesley K. Couture (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
3,ggGa. , 4. t./�
R\1411AA
Date
5/11/2019
uaamnamAI .aa
9 �.. mea61muma
• MA
0Le1W1la
American Installations MAH<prstrdiw4115982
su slmpmialwCann pun. s 1 mnw.
WdlM rand Pascual 2/28/2019
26Marshall5t � Northampton MA 01060
4135842353 dpas i@c nscnet
402935 M w 1¢0783
na
qLaftty Unit UnB Cost r,n Total
A r sealing
AIR SEALING 4 jroan hour $ 85.00 $ 340.00
WEATHEWRIP DOOR&ADD SWEEP 2 1each $ 80.OD $ 160.00
Air Sealing $ 500.00
Air Sealinglrcmb. $ 1500001
ArSeking WXBalance $ -
westneritatlon
ATTIC FLAT-8'FLOORED R-25 DENSE CELLU LOSE 486 'Dit $ 1.93 $ 932.98
ATTICDOGR-INSULATE&WS 1 each $ t10A0 1$ 13o.OD
COMMON WALL-PLASTERED STAIRWELL 1 each $ 175.00 $ 175.00
VEN ILATIONCHUTES 56 each $ 2.50 $ 140.00
ATTIC DAMMING-R-38 FIBERGLASS 76 uIft $ 2.05 $ 155.80
SHEATHINGACCESS 2 each S 35.00 $ ]0.00
XNEEWALL-R-13M )'RIGID BOARD LOS Aft $ 5.25 $ 567.00
Total WeathenEatlm $ 2.155.70
W,whed ation incentive $ 1,618.84
TWl]"Ji $ 2,655.78
Total M111ty Ont6butkn $ 21116.114
TWO Nstomer Colrtributbn $ 538.95
w. m., nwa.ray.uc.mwa«..m.a.•.awmno.:.......:u.Ir...:wlw.m:o.+�..nn
�btiMrc rV w.errpr=��.xmpnn mm.,Ai.mam,m•.aan.a..e.wa.pa.wr n..wa....xna..ew.•p.mw.,.mxwm.a aa.mw:m
Aaab`•b•tlrt ieal fanm Vmu a apM hu.•
Acavrpeapr emwsN.Tn.sme Pam•,.wamam,•um TOTAL CONTRACT VALUE= $ S38.95
dnapmm.n•nbbmmma.0 n.nM+a.paa.rau.n
.uawnaammwen a•wau4•d.rawnamwPn.us amrnpalm Down Payment= 5 170.00 `pF
a.naw«t.m ea.nme,.,,R=n cbmq.non. 1
] J/ Balance Due Upon Canpk[ion= $$ 36EVS
MacWer and Pamucd 2/28/2019
.... C.Oraeovich �m.n w 2/28/2019
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 Legibly
Name Business;organami.mmdi.advalF_American Installations,LLC
Address:_.130 College Street, Suite 100
City/State/Zip: South Hadley, MA 01075 ^ Phone if: 413-552-0200 �I
Are you an employer?Check the appropriate box: Type of project(required):
1.5XI I am a employer with 60 4. ❑ 1 am a general contractor and I i
P 6. ❑New construction
employees(full and/or part-time),` have hired[he sub-contractors i
> listed on the attached sheet 7 7. ❑ Remodeling
_.❑ 1 am a sole proprietor or partner-
ship and have no employees These sub-c.nVaclors have 8. ❑ Demolition
working for me in any capacity. workers'comp.insurance. I 9, n Building addition
[No workers'comp. insurance 5. ❑ We are a curporalion and its
re,pned.l officers have exercised their 10 L]Electrical repairs or additions
3-0 1 am a homeowner doing all work right of exemption per MGL I I Plumbing repairs or seditious
myself [No wmkeMcmnp_ c. 152, §1(4), and we have im 12.❑ Roofrepairs
insurance required.)+ employees [No workers' 13.❑Other Insulation
comp.insurance required.]
•Any applicam nor ckcka box N mast also Pot..the section below showing their warkers*womnoxition policy information
t Ilomeowners who nobrou this omdavit.cheating tbe,arc doing all work and then him otnsido conn¢tors moll submit o new Aidavit indicating sorb.
:Conor emrs me check al,no.must wrackd an additional sleet slmem,the name of the mbcommctmo and Ihar workers'comp policy information.
I am an employer that is providing workers'compensation insurance for my employee.. Below is the policy and job site
information.
Insurance Company Name: Guard Insurance Companies _
Policy#or Self-ins. Lie. It, URWC609917 _ Expiration Date 09/04/2019 _`
lob Site Address: I City/State/Zip: �mflL.n. r, n/� 6 166t
Attach a copy of the workers'compensation policy declaration page(showing the policy number and erptratton date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal perahies of a
fine up to$1,500.00 and/or one-year imprisonment,as well az civil penalties in the form of a STOP WORK ORDER and a tine
of up to 5250.00 a day against the violin.'. Be advised that a copy of this statement may be forwarded to tilt Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cerdfy,under the pains a/nd p,enaa/h/i�eess fel perjary that the information provided
)above
'i`s true and correct.
Sg<d/BAIE
413-55 -0200
Official we only. Do not write to the wren,to be completed by city or town official
L
r Town: Permit/Lieense Authority(circle one):rd of Health 2.Building Department 3.City/fown Clerk 4.Electrical Inspector 5.Plumbing Inspector
er
t Person: Phone#:
Caronronweahh of Massachusetts Conduction Supervisor
®� Division of Professional Licensure Unrestricted Buildings of any use group wlddr coetain
Board of Building Regulations and Standards fees Use 93,880 cubic feet(991 cubic meters)of enclosed
Construction Supervisor space.
CS-106178 Expires:09/29/2019
WESLEY COUTURE
218 LATHROP-STREET
SOUTH HADLEYMA 81073 3P
.... Fasure to possess a curter edition offline,Massachusetts
State Building Coders cause for revocation of this ikmss.
For InfomMlion about this 8cance
Commissioner Call(617)T213200 of visit www.mass.gov/dpi
r+/A1 (rfl iy7 J'ytfJ 3l flyE'fYtftl 111J �LCIJ3fYf�l tCJPS
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: 17596/2
130 COLLEGE STREET SUITE 100 Exxppiration: 08/26(2019
SOUTH HADLEY,MA 01075
Update Address read return card. Mark reason for charge.
scn� O tuio-osn n - Tl p_.ea.gr n f
Add:^_ Em¢raymert- []I ost Cnrtl
onsew Conwmer Aneinaauelneec Reautatien
- I HOMEIMPROVEMENTCONTRACTOR Registration valid tar irdivitlusl use only
TYPE:LLC before Ne axplratlon date. If Miami return to:
77
Registration Expiration Office of Consumer M
suer Affairs aBusiness Regular..
175992 0612612019 10Park Plaza-Sulte5170
MAERICM INSTALLATIONS,LLC. Boston,MA WAIS
WESLEY COUTURE
IM COLLEGE STREET SUITE 100 (� (valid WlShOUt signature����
SOUTH HADLEY.MA 81075 Undersecretary /
---IN onananYn
A✓RH CERTIFICATE OF LIABILITY INSURANCE -9/4/2018
9/4 Yao1e
THIS CEf1TIFlCATE IS MUM AS A NATTEII OF INFORWTON ONLY AND CONFERSNO IaGH15 UPON THE CERNFlCATE t10LDER.110S
CERTIFICATE DOES NOT AFFlRWTIVELY OR NEGATIVELY MEMO, E%TEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), AU RQEO
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
MPORFANT: N HIS CaNblcals holder IS an ADDITIONAL INSURED, file palcy(las)nuen W andomed. N SUBROGATION IS WAIVED,sub)M W
We terms and eal0lUons of Die poky,certain polWls may require an andomaman5. A ststemen on MIS cefdReate does Ind Confer dghla W the
comficale holder in Ilw of such s s.
.CAN Linda Paaery
Rabbar a Drima 11 RMIE (413)596-0111 .duus4-feel
a Nib W King straat ^IL .lyoasraaArabharaodOriTmell.Com
IN9111E AFIORgNO COVERApE HYC•
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IXWRED RERa9ar}a1111e H6t}1a9A OIIAAD Ine. Co.
American Installations, LLC mURER e:
Attn: wee & 9M.. Couture Ilpu O:
130 Collelre Street, Suite 100 PSUREFE:
South Radley RA 01075 N FPI:
COVERAGES CERTIFICATE NUMBERJAascar Sam 9-2019 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLCIE$OF W+UMNCE LISTED BELOW HAVE BEEN ISSUED TO THE NSUREO NAMED ABOVE FOR THE Po(ICY PERI00
INDICATED. NOlV9RHuTANDINO ANY REOUIREMENT,TERM OR CONDITION OF MY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUCES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C MS,
MM TYMOFMWMNCE MWVMNKA EiF ® Lllatf
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PFnRCN.LLBAWINIURY S 12000,000
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE MWRIBEO FOL IMES BE CANCELLED BEFORE
BOidenCO Of I...S CO - TH! EXPIRATWN DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNm1D®REPRf:BFIffATVE /!/1
W Czi.nnell, CPCU, CSC
01989-2016 ACORD CORPORATION. All Hghm TNervetl.
ACORD 25(2014!01) The ACORD name and logo are registered merle of ACORD
IN302b Iz9Ha11