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36-229 (6) 44 WINTERBERRY LN BP-2019-1303 GIs k: COMMONWEALTH OF MASSACHUSETTS Mamillock:36.229 CITY OF NORTHAMPTON Wt:•001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS permit: Bulldina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MOL e.142A) Cateaoa: INSULATION BUILDING PERMIT Permit a BP-2019-1303 proiecta JS-2019-002101 Est, 51600 00 I`=$65.Oo PERMISSION IS HEREBY GRANTED TO: Const.Claw Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sa. ft.): 104544.00 Owner: WRIGHT RACHET. Zoninw App&ant: AMERICAN INSTALLATIONS LLC 9T44 WINTERBgRBY LH AoMdcant Address: Phone: Insurance: 130 COLLEGE ST (413)832.0200 WC SOUTH HADLEYMA01075 (tS. M QNUl 7/2079 0:00:00 TO PERFORMTHE 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: Housed Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Ir t)eoartment Fireplace/Chimney: Rough: Qui Insulation: Flgelt §Iqghill Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Sienature: FeeTvve: Date Paid: Amount: Building 3/1720190:00:00 $65.00 212 Main Stmet,Phone(413)537-1240,Fax:(413)587.1272 Louis Hasbrouck—Building Commissioner 1°l- itio� /9-1u- /-IS03 �CC Oep City of Northa [[��''m$ltb1 c ..> - Building Department SNS ULA T/ON 212 Mar Street MAY 5 20' Roort1100 Northampton, MA 01060 phone 413587-1240. Fa* IHBFFc ONLY NOnTMAMPTON,MAOH APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION I.SITE INFORMATION INSULATION PERMIT 1.1 Property Address �jTThhiis section to be ccornptta� by office Map $' _ Lot _Unit 44 Winterberry Lane Florence,MA 01062 zone, Oyeriay District Ean th.Oisbkt CBoisnlct SECTION 2-PROPERTY OWNERSHIPIAUTHORDEDAGEHT 2.1 Owner of Record: Rachel 44 Winterberry Lane Florence,MA 01062 Noma rM) n See attached 7g-54a 4031364a Telephone Signaere 2.2 Aullegrized Agent: American Installations 130 College Street Ste. 100, South Hadley,MA 01075 Name(RFD Cwmnt Mearg Address: (413)552-0200 Signal" e SECTION 3-ESTIMATED CONSTRUCTION COSTS Nem Estimated Cost(Dollars)to be Official Use Only completed bnnit applicant 1. Budding $1,600.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from B 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 0 S. Fire Protection S. Tutml= 1+2+3+4+5 $1600.00 Check Number This Section For 011lclsl Use On Building Peand N bar. Date Issued: Signature: 5-►1-ZO 19 Bu dio,Commeaionefflnspector of BuIdWs new EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder FVesley K. Couture 106178 Lkerne Number 130 College Street Ste. 100, South Hadley MA 01075 9/29/2019 Address Expiration Dery Ce,,�� (413)552-0200 6pnafurs Telephone 9.Repbtemd Nome Snproy nt Contractor•. Not AppICWM 17 American Installations 175982 Comoam Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 6/26/2019 1Addrese Expiration Dab 1fJQJa�xan k Telepbms (4131552-0200 SECTION 6-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,1 4SC(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....... M No...... O Brief Desorption of Proposed Work NOTE: INSULATION ONLY Attic insulation and air sealing throughout. I, Wesley K.Couture -American Installations as Owner/Authonzed Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the beat of my knowledge and belief. Signed under the pains and penalties of perjury. Wesley K. Couture PM1a Name Ya�.x;� v- (�fo�1.�11A-- 5/11/2019 lure of erlAgenl DMB I. Rachel Wright as Owner of flee subject property hereby authorize American Installations to act on my behalf,in all molten miseries b work authorized by this building permit appllwGon. See attached 5/11/2019 Signal.al Owner Dan? City of Northampton Q7 / _ Massachusetts OI �� c `' '� DETMIMOrt OF BLDIMi INSPIUMIONS �, 212 coin atrwt 0 Wnleipsa avildinq •l' F 9oreha ton, M 01060 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 in renowniom on detached one to four family homes.Prim to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction,aaerafi m renovation,repair,modernization,conversion, improvement,removal,demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not mom than Pour dwelling units....or to structures which are adl'acent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered TypeofWork: Insulation Est.Cost: $1,600.00 Address of Work: 44 Winterberry Lane Date of Permit Application: 5/11/2019 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under S 1,000.00 Owner obtaining own porn it(explain): _Building not owner-occupied x Other(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.C.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 pern it as the agent of the owner: 5/11/2019 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 1 ! f q t 'I Y� ➢CPMTin S 0 elftniNG' INSPECTIONS 212 lLin e[iw[ elh,eioipal Building 1 � !"� NaitLimp[on, NA 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: 44 Winterberry Lane (Please print house number and street name) Is to be disposed of at: Waste Management o New England, Chicopee, MA 01020 (Please print name and kradon of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) /D>,QAu. �. � 5/11/2019 Signature of nnk Applicant or Owner Date If,for any reason,the debris will not be disposed of as indicated,the Applicant or Owner shall ratify the Building Department as to the location where the debris will be disposed. ��l!_J• wwlmvrkvNrblbrbv.¢m B6B � u4mre4a Immee ® - Nu 6xATaxR American Installations ma Repl:rmxmn gxnoel snraa.suer wn.xm,scum sW W.xuomn.(xMn:1.131 ssxdmero:1.x31 eelamx.rv.w:ay..rtpxruro.nammn.mm Wright Rachel 5/6/2019 Ik WlnyerberryN iM Florence MA 01062 903.316.5544 483311 m 19-1407 Wn Quantity Unit Unit Cost +n Total AIR0 AIR SEEALINALIN G 4 man hour $ 85.00 5 340.00 Air Sealing $ 34040 Air SsalinglocentFae $ (34040) Air Wising M Balance $ - weatMrint ATTICFLAT-9'OPEN R-33CELLULOSE 420 Mft 1301$ 630.00 ATTIC DAMMING-R-38 FIBERGLASS 22 left $ 2.05 5 45.10 VENT BATH FAN THRU ROOF 1 each $ 118.75 $ 119.75 ATTIC HATCH-SUL&INSULATE 1 each 60.00 60.00 WHOLE HOUSE FAN COVER 1 each $ 209.21 $ 209.21 VENNUTION CHUTES 55 each $ 2.50 $ 13730 Total WeatheNxa60n $ 1,20036 Weatheriaation Incentive $ 900.42 Total Project $ 1,540.56 Total Utility Contribution 5 1,240.41 Total customer Contribution $ 300.14 ""No Mvr nI'Mosset Ll elll Pm W'th'u-1 mon h—....rwlrh 1 11,k-1hlOwvrranry. n Innv4nvrr,LLC Mrq pepea m N mM ar murOl ane Ivb m eenplvn Ne vbn uerc of won in uoreane wnn me vetK rpn karma vM Y KKY rtl 4b N W awe o..a.n"r<m mau.0 vmm m auaa r.,n.. MOLIKMa of Plosi me Brow P,Ims.aomfialmm a la TOTALCONTRAUVALUE• 5 300.14 mrdoen-o nabounaw.mnerea—wea.rw.m .mnonmame..en.aaPwnwa.Pavm.m wliiro Ua cow.Dram Down Payment= $ 100.00 ©saxoxa :r.nm.mt...aaL.ma...Pw�r�mPl.rroe. Balance Due Upon Compledon= $ 200.10 ID Rachel Wright 5/6/2019 C.Dragovich 5/6/2019 THISOGREEMENF ISCOMPOREDOF THIS PAGERNDTHE REVERSE SIDE OF WIS PAGEANOSNAILBECON510ERED THE ENTREAGREEMENF BYTHE PARE ES INVOLVED.MISAGREEMENT 15 BETLVEFNAMERNAN INSTALLATIONS,LLC HEREI ANTER REFERRED MAE-OCMMNP,AND WE NSTOMERMI NAMED ON TIE REVERSE SIC£.HEREINAFTER REFERRED M AS"CLIENT.AND WHI SESUNECTTONLAPPROPRMTE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACNUSET6CR CON NECFICUTROPECTIVELY,AS WELLAS ALL LOCMJUR15DIUIONS. THE MUU WLNG TERMS AND CONDITIONS ALSO APPLY I THIS AGREEMENT 15 SUBIECI TOME APPROVAL OF A MANAGER OF ME COMPANY FOR WIS MOVEMENT M BE EFFECTIVE UNDER MIYCOMIIMN. 3.SHOULD DEFAULT BE MADE IN ME PAYMENT OF THIS AGREEMENT CHARGES SIMLL BE ADDED FROM ME DATE THEREOF AT A RATE OF ONE AHD ONE-HALF I1-1/31 PERCENT PER MONTH. (M PER ANNUM WIN A MINIMUM CHARGE OF$3 W PER MONTH,AND IF PLACED IN WE HANDS OF AN ATTORNEY OH COLLECTION AGENCY FOR COIECIION,ALLATMRNEYT FEES, OPEFGES AND COSTS OF COLLECTOR SHALL BE PAID BY TIE NEM.W POWDER,DIEM UNDERSTANDS THAT IN FMUNG M MY AMUFUN G MTHE AWARE TERMS,COMPANY MAY HAVE THE RIGHT M A LEI ON ME PROPERTY, 3.THE COMPANY AGREES THAT WHEN OKAYS BECOME KNOWN TO THE COMPNN.ME COMPANY WILL MONY ME NENT M SNH AS REASONABLE, <.COMPANY AGREES TAT,NOTINTS TANONG N!I AGREEMENT FOR MATERIALS AND/OR UABOR BETWEEN COMPANY AND THIRD PAM,COMPANY N RESPCNSWF M NEM FOR COMPLETON OF ALL WORK DESCRIBED INATMELYAND WORKMANLIKE MANNER, 5.ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SLIMED BV ME CCMPAW UNDER TINTS AGREEMENT SFWL BE MORE GIVEN BY ME MUNNUM CNRERS OF SUCH EQUIPMENT ARID PRODUCTS.UNDER SUCH AWIUFACRIRERY WARMHSIES,THE OEM NEW Y REQUIRED TO REGISTER OR MAIL IN A WMMIITY CARD OR OTHER ENDENCF OF OWNERSHIP AND USI OF SUCH EQUIPMENT AND/OR PROW CR IN ORDER M ACTIVATE SUCH WARRANTIES. 6.ME NOTATION ON ME PAGE HEREOF ODES NOT INCLUDE pPFN$FS OR CHANCES FOR BOND OR INSURANCE PREMIUMS W CURIS BOO DNORM.LL INSUMNO COVERAGE ANY SUCH ADOIIOAL OPENSFS,PREMIUMS OR COST SHALL BE ADDED M THE MTAL.W REEMEM.SMOUM. ].ME COMPANY$UABIUTY FOR CLAIMS AR51NG OUT OF MIS AGREEMENT SHNLL NOT EXCEED WE TOTAL AGREEMENT PRICE EXCEPT M THE EXTENT MORE DAMAGES ARE PROVEN TO BE SOEY WE TO THE COMPANY NEGLIGENCE. 8,WANG ME DURATION OF THE WORM,THE NEM'$HOME NAMES INWMNT WILL BE RESPOYMBLLE FOR AM AND ALL DAMAGES M LONG AS ME COMPANY HAS FAXEN ME APPROPRIATE ACTIOHTO PROTECTAREM OF WORK. 9.ME COMPANY IS NOT RESPONSIBLE FOR PROULETWG DERC ENOES OR H6WROXUS MATERIALS THAT MANIFEST THEMSELVES DURING ME CONSTRUCTION PROCESS EG.WOOD ROT, MOD,ASBESTOS,MNL POS,WOWCNK AND CONNECTIONS,PLUMBING AND VENT NIPS,(ROVING DEFLECTION.ETC IF A PRE-0LLGTNG DEFICIENCY OR NVAROA S HATER AL IS ENCOUNTERED PRIORTO OR DURING CONStRUCRON,AND COMPANY 15 NOTIFIED IN WRITING,COMPANY WILL TRY TO AGSM NEM WRHHN ME WMPARTS MEANS AND CAPABILITIES TO CORER ME PROBLLEMD)ON A TIME AND MATERIAL WIS.CLIENT AGREES MAT SUCH CONDITONS ANE UNAVOAVLE BY ME COMPANY AND SMALL NOT BE CONSIDERED A VIOLATION O THE KAEENU M AND THAT WE MTMFSE CONDIIIOHS WE DURATION O ME WORK AND SOHWLLED DATE OF COMPLETION MAY OFFER FROM TAT,WREED UPON,If APPLICABLE,UNDERTHIS AGREEMENT. IO,THE COMPANY IS NOT RESPONSIBLE AND THE CLIENT AGREES M HOLD ME CCMPIW HARMLESS.FOR AW PROBLEMS AND/OR DAMAGES,INTRONS BUT NOT LIMITED M VIDEO GROWN,ARISING FROM THE PERFORMANCE O MR SFAUNG WOA BY ME COMPANY AS A RESULT OFANDY KNOWN OR UNKNOWN MOEFUM CONORONS. 11.THE COMPANY 15 NOT RESPONSIBLE FOR AND ME RENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES RELATING TO ICE DAMMING THAT MAY ARISE WRING ANQFM AMR ME PERFORMANCE O WON BY ME COMPANY. Il.REPLACEMENT Of DETERIORATED DURING,PASO$BOOM,FORCE ACK$,VENTILATOR(FLASHING,METERS,RI INSULATION M OTHER MATERIALS AM NOT INCLUDED UNLESS OMEAl NOTED HEREIN. 13.ME COMPANY WILL NOT BE MSAWSINE FOR ME SCRATCHING OR DEWING O INTERIOR WALLS AND CEILINGS,FLOES,TRIM,GURERS OW/MFOUS EARMAI Slum AND WHNWNE CHOIRS,OL DROPLETS IN DRIVEWAYS,HNIANE FTACNRES IN COIOEIE DRBUIXTOP OBVESAND WALKS,OR DAMGEM PUNTS E SHRUBBERY If EXCESSIVE DAMAGE I5 UVYD BY COMPANY,COMPANY WILL REPAIR OR REPLACE DAMAGED AREA ONLY AT COMPANY'S EXPENSE. ]l THE COMPANY UNDER PROVISIONS OF CHAPTER lUA DEME GENERAL LAWS 15 REWI REO M APPLY FOR AM OBTAIN AL CONSTRUCTION-RELATED PMAUM.ME CCM PANT SHALL NOT BE DEEMED RESPONSIBLE FOR DELAYS IN ME WOE DESCRIBED IN MIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING E BIDIRECTIONAL AGENCIES,AUTHORITIES,E INDIVIWA6. 15,TMS AGREEMENT,INCLUDING THE PROVISIONS REUTINGTO PRINCE AND PAVMEMSCHEDULL.CANNOT BE CIANGEDOR ALTERED EXCEPT BNA WRRTMETATEMEM SIGHED BY MINIMS COMPANY AND THE CLIENT. 16.ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATOR NOT WRITTEN ON THIS AGREEMENT ARE AGREED M BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND W NOT WAVIVE THE EXECUTION OF MIS AGROMEM 17.MRS.WROMEMCANNOT IRE CANKELLED WHTHOUTTM MUTUAL WRITTEN CONSENT OR BOTH PARRIES EKOPT AS OTHERWISE SFT MEW MEM. IB.WIS AGREEMENT,AND ANY WARRANTY(5)PROVIDED HEREUNDER SHALL NOT'BE ASSIGNED OCE"BY E WIN ME WRITTEN PERMISGOW OF ME COMPANY. 19.IF THE NEM FARES TO PERFORM ITS OW WTIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT ME FUCA WAREN CCFISEM O ME COMPANY,ME NEM SHAUL BE UANF FOR DAMAGES FOR ME GREATER O ME COMPANY'S ACOA DAMAGES ON 25%O HE AGREEMENT FOR RESTDOING FEE. W.ANY CHANGES M MATERIALS BY ME CLIENT(BRAND,STYLE,COLE ETC IAMR SAD MATERIAL HAS BEEN DELIVERED OR IS IN NO LTE TO THE NEW COULD RESULT IN A 5%RE FEE RASED CN ME COST O BAD TMTERRALS Sl.TONS ABHORRENT WILL RE EFFECTIVE ONLY UPON ITS EXECUTION M ALL MEMO HERETO,PRIOR TO WHICH TIME IT ANAU BE DEEMEOA PNOPOSLL ME COMPANY RESERVES ME RIGHT M REVOKE MIS PROPOSAL 90 DAYS FROM DATE M N EXECUTED BY ME COMPANY IF IT I$NOT EARLIER EXECUTED BY ME NEM AND ME REQUIRED DOWN PAYMENT RECEIVED PRIOR TO ME EXPIRATION O SUCH 90 DAY PEROP AMR 9D DAYS AND IN THE EVENT COMPANY WFS NOT MORE THE PROPOGL,COMPANY RESERVES ME ROM TO RELAY ITS RAKE IN POO DANCR WIN ITS COSTS 1N EFFECT AT SUCH TIME $$.IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVAUD OR UNENFORCABLE,THE VAUDITY AND FNFORC£BNTY OF THE REMAINING PROVISIONS OF THIS AGREEMENT SHALL NOT BE AFFECTED THEREBY. 33.ARBITRATEIN ME WENT THEOREM AND COMPANY RAVE A OSPURE REGARDING ANY O THE TERMS,CONOROM,PROVUNDAYS,ON PERFORMANCE OF WIS AGREFMEW,ME RATIONS AGREE TO PLACE THE MATTER IMO ARBITRATION BEFORE AN INGO EN DEM AN NNITOR ASSIGNED BYFIN E AMERICAN ARERRATI ON AS$OCIATIO N TO RESOLVE THEIR DISPUTE. 20.AW(RECOUNT,MCWTON,REIMBURSEMENT,E OTHER RAOGRMH THAT U PART O A STATE SPONSORED UNITY PROGRAM UE,MASS SAVE01 G W WE M ME AVAWIURY O QUALIFYING STATE SPONSFRED PRW RAM AND WILL BE SUBJECT TO TERMINATION IF ME STATE SMOLDERED UTILITY PROGRAM 6 CSCOUMINUED.FURTHERMORE ME TERMS AND CORROSIONS O STATE SPONSERED UTILITY PRWRAMS MAYBE ALTERED E LIMITED PERHWIULLY WIN OR WITHOUT NOME E5.MRRICAN IRSTYLEAS.LLCM NT AN AGENT O.WY UMTY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,E UNDER ME MSSS SAVE*EMERGE NKKSMM. 26.NEM ISBE"ONIBLE POR THE PAYMENT OF MT AND ALL RDEFU STATE,E LOCAL TAMES THAT ME APPLICABLE TO MIS AD REEMEM. 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 Leably Name Musinesr/Organismoldladividuap: American Installations,LLC Address:_ 130 College Street,Suite 100 City/State/Zip: South Hadley,MA 01075 Phone M 413-552-0200 Are you an employer'Check the appropriate box: Type of project(required): I.N I am a emplover with 60 _ 4. ❑ I am a general contractor and 1 6. ❑New cmmtruction employees(full and/or part-time).' have hired the mb-connactols 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These sub-conoa,ton have a. ❑ Demolition working fm 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 10.E]Electrical repairs or additions 3.❑ 1 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..,kers' 13.®Other Insulation comp.insurance required.) "Am rppaicml nava clicks box p I masa abs fill out aha smumb blow sM,wing aM1cir wohari conimusnbn policy infmmeafun. t I Inmeownen who submit bb alraavu indkaing they arc doing all work end u.,him nuuido cnmmemrs must submit a nvw nlTxLvil indleolieg sorb. C'unnaclors Ilal da+a nrs boo rasa anaJud an aJJisioml sheet rM1uwing @e nano of the wh-canvmams vd ahcir workers'comp.polis inro,maaion. I am art employer that is pmvdding workers'conWmarion insurance for my employees. Below is the policy and jab site information. Insurance Company Name: Guard Insurance Companies Policy q or Self-ins. JLic.It: URWCSN917 Expiration Date: 09/04/2019 JobAttach Address: hl_ �:�fL� ni thepolZip:�e� Attach a copy of the workers'eompeasation obey declarnfion page(showing the policy paraben and expi tion dale). Failure to secure coverage as required larder Section 25A of MGL a 152 can lead to the imposition of criminal pemkies of a fine up to$1,500,00 aaaUor 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 of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hem ceenii under the pains and penaddes of perjury that the information provideda, Dove is arse and correct. Simature�hLl/✓Ld 2l"L a & Dow: Phone k: 413-552"0200 Official use only. Do not write in this areas to be completed by city or town offmiaf City or Town: Permit/Lice tse a Issuing Authority(circle ase): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone a: Commonwealth of 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(991 cubic meters)of enclosed Construc4bn Supervisor space. CS-106178 Expires:09/29/2019 WESLEY COIRME 218 LATMROPSTFI SWTH 11I1DLEY MA 01078 Failure to possess a curert edition of the Massachuse", State Building Code is cause for revocation of this license. For Information about this license Commissioner Call(617)727-3260 or vied www.mass.govlCpl rl//( - �t 5 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: LLC AMERICAN INSTALLATIONS,LLC. Regxpiration: 175982 Expiration: 08/26/2019 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Uptlete AOdh a,snd return card. Mark reason for change. Seel 0 atuU h M— Ade - r'I rl FrnM0ym001 F3(.981 fiPr4 '/�iry r rirurr rrrrrvi�/�i r�'��r:vrr'�ixw'//� OlpeeolEIMPRer ARehsaeuvWR CTOR on ';L i/ XOMEIYPROwn:I- CONTRACTOR Rogistrauluen evsldfor it a, If found rehy TYPE:LLC Office Ne Consumer dale. If found velum lo: 1i{ Aenletratian 06Excitation19 Dinka 011axa- 1110r AIfa1r9 aid Blmslne99 Ra9YlatlOn Y .�? 175982 OB'2fi12019 10 Park Plata-Suite 51]0 AMERICAN INSTALLATIONS,LLC. Boston,MA 02115 `/� 13000I COUTURE \ZGcErp--� 4 114r 130 COLLEGE STREET SUITE 100 U r t� 5� SOUTH HADLEY,k1A 01075 Ufmllasectedl7 " ', t Id yMtlloat signature AC Rd CERTIFICATE OF LIABILITY INSURANCE -;-a21a" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MO MGM UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE ODES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE ODES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S) AUMOR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: It the Dertificats hoMar Is an ADDITIONAL INSURED,the pollcy(leg mutt W andoraed. H SUBROGATION IS WAIVED,aub)ect to Me terms and coneJklons of Me Felty,certain pollclee my reguIrs an andorvHn A amMlNnt 6n We cerlBcate does not onoW d"to the cargflcete holder In Bleu of such erldwu s. F.A. CONTACT Ltade MWW 0 Webber A Griwll ^'m'E , (6131566-0111 PA[ant g13IDthtY1 6 North Ring streetM.art �'N^IL .112oaWraWWabLarendBrl®all.aa 49aasn _..pt on m 01060 W A�1 MOtaal C&AWAL1tY mss® e9arkahire B• O . Co. hearleen Inetallatima, e.•^ •WYRea C: A[[nr Wea A Sur. Cart. •pU... 130 Colles 6tree0. Bn1te 100 MUMA E: south Badley NA 01075 ..E COVEfUGES CERTIFICATE NUMBERIlBater Rala 9-2019 RE RASION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE MUCY PERIOD INNCATED. NOTMTISTM1gN0 ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRIT RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBIECT TO ALL THE TRIM. EXCLUSIONS AND CCNDRpNS OF SUCH POLICIES.LIMITS SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. IYRW NIXIMX2 PO YHP PoIIcr XA IYXIX Cee104lK0eaeWLIM�rtY .pCC,.g.E a 1,000,000 l HAy®yaOE ❑ DODDS F5 a 5001000 503135211 9/"]010 9/"]019 1Al)EIP ,pJ a 10,000 PERSONAL BAWIWUW S 11000,000 .M>dEOAT IJNUAmIES. aExvul A...EGATE t 2,000,000 i PoLIcv�N �Id' agooucTs.w.'q AOp 21000,000 oT<n $ /,InOYONLE wBIUTY NEO i 1,000,000 A ANY. eonrlxxmtPwomO s ASO EO i A 5nneall ./mala 9/4/2019 eOgLv lr{X1Mp►alHae t i rexm AUf06 S NOVO PROPHRVO I W CIA i WXamea, I Pf t 61000 i IIWWWWa OCgM ECNOP.1"WWIE 0 1 000 A form U. InnRWTE a 1100010" Do I i I ,Mons L0.00. aa52v 1/2/2015 11112011 WOMSi COWPEN9A. W •XO'..OrTa4n.T fR ♦/a CPFVL FUNEMEP EI.LN'OV ECIIINE IIIA EL F.Wl1Ap.1LEM 000 B IMeyFpy x N10 ®C605911 9/41101• 11,12019 Et pIBe9F.FA a 500 000 9 Q�oPEPAPOxS Miw t Wr 00 A t—.i.1 PzoaertY Sa3333217 91412010 91412029 64Y g. OBCHPfION OF OPERAPONS f LMADDIRS/VHaLlE9 ggWO1m.M90mFl Remvb 9tleeis r,a5 peF4ye0X mwE90YeaY•e CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence OE InaVrance THE EIDIUTON DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTIM)PUEe PEPRE901RMIn N Grinnell, CPCO, DID f✓-1F�--- `� �' 01OWM14 ACORD CORPORATION. All Hpllb reserved. ACORD 25(x01 AN01) The ACORD name and logo are reglaterel marks of ACORD INS025(1a:aan