23A-181 (4) 16 PINE ST BP-2019-1349
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:23A- 191 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv: INSULATION BUILDING PERMIT
Permit# BP-2019-1349
Project# JS-2019-002175
Est. Cost: $2700.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License.
Use Group AMERICAN INSTALLATIONS LLC 106178
Lot Size(sa. ft.): 20298.96 Owner: PYLE KEEGAN
zoning:URB(100)i Applicant: AMERICAN INSTALLATIONS LLC
AT: 16 PINE ST
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:5/28/2019 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:
FeeType: Date Paid: Amount:
Building 5/28/2019 0:00:00 $65.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
(41
Dep
City of North mpt
Building Dep me t 4
212 Main S eat MAY 2 2 SVLATION, #
Room 10
Northampton, M 01 '
, nvrun p70
phone 413-587-1240 Fa 41 -5@Tu1 TO" 11 0" '
ONLY
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTIONI -SITE INFORMATION INSULATION PERMIT
1.1 Property Address This section to M c,o�mp,leted by office
]
16 Pine Street Map�l.� Lot 1Unit
Northampton, MA 01062 Zone _ Overby District
Elm at District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Pyle Wilson&Keegan 16 Pine Street Northampton MA 01062
Name(Pdna Current Mailing Address:
See attached (4131346-8630
Telephone
Signature
2.2 Authorized Agenic
American Installations 130 College Street Ste. 100, South Hadley MA 01075
Name(Print) Current Mailing Address:
1,,)�#� y �,Lq LQy uL2d (413)552-0200
Signature Teleptrine
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to oe Official Use Only
completed b "it applicant
1. Building $2,700.0-0 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from S
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) $2,700.00 Check Number c3
This Section For Official Use Only
Date
Building Permit Nur. Issued
m : C
Signature: 5 ZB" 19
Building Commissionedlrepedur of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION e-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Namaof LldMeHolder. Wesley K. COuture 106178
License Number
130 College Street Ste. 100, South Hadley MA 01075 9/29/2019
Address Expiration Date
(413) 552-0200
SgnaWre Tekphom
9,Registered Home Improvement Contractor. Not Applicable ❑
American Installations 175982
Company Name Registration Number
130 College Street Ste. 100, South Hadley MA 01075 6/2612019
Address Expiration Date
-IAr.n Telephone_{413)552-0200
SECTION S.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S))
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....... )a No..... ❑
Brief Description of Proposed Work NOTE: INSULATION ONLY
Attic and basement insulation and airsea ling throughout.
I, Wesley K. Couture - American fnstattations as owner/Authorized
Agent hereby declare that the statements and information an the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Wesley K. Couture
Print Name
Cs), 5/22/2019
SignaWrecf crit
Data
Pyle, Wilson &Keegan as Owner of the subject
property
hereby authorize American Installations
to act on my behalf,in all all matt�ers relative to work authorized by this building permit application.
SQ-Z cf- l /1019
Signature of Owner Date
City of Northampton
`
Massachusetts
I D&PAR1'MEN2' or BUTWIM INSPSCTIOBa
212 Win Street • Municipal Building
F Morthemptv,, MB 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 or renovations on detached one to four family homes. Prior 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, alteration, 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 more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note.Lfthe homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: Insulation Est.Cost: $2,700.00
Address of Work: 16 Pine Street
Date of Permit Application: 5/22/2019
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
Building not owner-occupied
x Other (specify): Contractor pullingpermit 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:
5/22/2019 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
Kassauhusetts
D£pM12e°trl' OF at22LDrM ZNapEt Ms
212 aein Stra t osw aipal euildin,
Nai the t..' ax 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:
16 Pine Street
(Please print house number and street name)
Is to be disposed of at:
Waste Manligerrlent o(New i?nt'lancf1 Chicopee, MA 01020
(Please print name and location W facility}
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address) ! 1
DD Ale �� Alt.�t �.l.l ' 1.`2311 r1
SI nature of- �.Ptrmit Applicant or Owner Date r�—
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
z 'r Massachusetts
n>:ezaz NT of sorinssc zasrscrroxs i.
�,.. zlz Mein aCe..L • Municipal Building
r, c'
sexrde.pcen, w. oaosa
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: 16 Pine Street,Northampton MA 01062
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley MA
Phone: (413)552-0200
Property Owner
Name: P)rJ, WiIcnn w Ke,g,m
Address: 16 Pine 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 /.
I ��rB J—,LI/t Ae
Date
'~~
2� � wwx.imwMnn,bx.Ywar,m
• ti: an&IrtWee
Maw \ MACSL ]051)8
Arrlerieen Installations Mx Regisaanen#vs982
v9aaNpa.rswusoaammlmlaY w.mm:.oax autssa.mePramaulsuoto+•atlw:wPPtln�xm.lu.aeu+.ema.mm
_Pyle Wllsanffi Megan 7/26/2018
16 Pine St �. Nw hampwn MA 01062
rw.+ as m.n mx
4131168630
1-1 425256 w "..n 111,1610
=.m Qwa Unit UNt Cost wen Total
Ak SeaMg
AIR 1111G 10 I.a.how IS MOD I$ 850.00
WEATHERSTRIP DOOR&ADD SWEEP 3 each $ 8000 $ 2440D
Alr$ealing $ 1,090.00
AF Sealinglncentive $ IL020001
Alr Seaing Wg Balance $ T0.00
We rtherltatlen
ATTIC FLAT-4"OPEN R-14 CELLULOSE 8B&1qft $ 1.201$ 1,065.60
AMC DAMMING-R-38 FIBERGLASS 110 I.Qft $ 2.05 $ 225.50
VENTIIATIONCHUTES 66 Jmh $ 2.501$ 165.00
CRAWLSPACE-EMIL GROUND COVER 109 Fqft $ O.TS $ 83.16
Air Sealing W2 Ba e 1 lump sum $ TO.OD $ ]0.00
Total Wead uiration $ 1,609.26
Weatherlta0on lrleen9Y9 $ 1,206.95
Total P.IM $ 2,62916
Total L"4conbbutlon S 2.226.95
Total Cusmmm Comrbutbn $ 40132
waaMHlY:Mailon In.M1M11xu.LLCnInPmHn W aM�bMM1wnmwnn,Mtl,.i1.awM1nuiMgwmirtY.
•,reM.nlvWUKm.u[Iv.ba�gmwm Mnld Yl maMNlW nCummm}.tlMabn.vuwerwrtF wmrHro�ML Wapavp.Mmlbna.M Y1A In-0aM
Wptlq,quy4n.p,tlwTevl6nmuVMnnalautl M,tlR
ace[eraxeroraaovwu:TMaeoreygecsPe��mnam4 TOTALCONTFARVALUE= $ 40132
mnOttbn+an utl.ntloryaNareMMYa<eVrnG.Yauan
atlgmm.emaowertas waoem.P•YmaN ww MVamw aar Gown Paymem= $ 134.00 ❑
b narttlwek,aM WURr4ue YpOn CaTyialbn PNe
BalarFa Due Upon Completwrl= $ 26932
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uwenmuweu�'.==wumuie4lwummw,mmwmnnimwomw van�u=rmrtfw.mmuiwAw[�u'n uawien wv wpxrm�s�w�mWwwnt�m
iLx 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 Le 'blv
Name (Baslnesuorgant,admNndlvidual): 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.❑ Lam a employer with 60 4. ❑ I am a general contractor and 1 fi. ❑ New construction
employees(full and/or part-lime).' have hired the subcontractors
2.❑ I am a sole proprietor or partner-
listed am the attached sheet t T E] Remodeling
ship and haveve no no employees these sub-contractors have 8. r-1 Demolition
working for me in say capacity. workers' comp. insurance. 9. [] Budding addition
(No workers'comp. msurmec 5. ❑ We are a corporation and its
required.] officers have exercised their I0.❑ P.lectrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL. 1 1.LJ Plumbing repairs or addi[iorls
myself lNo workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.]t employees. [No workeri 13.❑t Other Insulation
comp. insurance required.] —
'Any applisanl Thal checks hos HI muss also lilt out da,se Yion below showing tiair workon'compcnsmion policy information.
y I lomaowncis who submis an,afidavit indicating dey an doing all work and Nm him outside cammdors must submit a mw allidava odnatual such.
:Convaclors Out chuck this box mmt anacllevl'an attached sheet ehuwing ne nnam of file.spbtommetors and user workers'comg.poh,infiv-1 ov.
I am an employer that is providing workers'emo pensahon insurance for me employees Below is the policy and job site
information.
Insurance Company Name:_ Guard Insurance Companies__
Policy art Lieh: URWC609917 _ Expnation Dates 09/04/2019.__
Job Site Address:_`(, 0 j(V ( n,)r City/StatelZip:. (✓A o]0('Z
Attach a copy of/he 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
tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a tine
of up to 5250.00 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.
Ido hereby cerrify,under the pains and penuldes of perjury that the information provided above is true and correct
Signature L�Iti✓L /�IGJAtA __Date:.
Phone#: 413-552"0200-
Official use only. Do not write in this areµto be completed by city or town offrcinif
City or Town: Permit/License N
Issuing Authority(circle one):
1 1.Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone H:
Cnnmonwailth of Massachusetts Construction Supervisor
®� Division of Professional Licensure unrestricted-Buildings of any use group which Contain
Board of Building Regulations and Standards Gess than 95,000 cubic feet(901 cubic meters)ofencbsed
Construction Supervisor P.C.s
CS-106178 EBpires:09/29/2019
WESLEY COIRURE
218 LATHROMSTREET -
Mmf MMEY MA 01075
Future to possess a currant edition Class,Massachusetts
SMB Burry Code is caux lorrerocabon orchis face ese.
For Information about bilis icarlss
Commissioner CAI(SM 727.3200 w visit yeVw.moss.gov/dpi
rxAW)R0707 /1' a C�/��trkl(rc�ctfe s
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: LLC
AMERICAN INSTALLATIONS,LLQ Registration: 175982
Expiration: 06126/2018
130 COLLEGE STREET SUITE 100
SOUTH HADLEY,MA 01075
Update Addneas and return Cold. Mark reason for charge.
SCP 1 O 21I1Ag591 n n o_..«..,�f-ddf� n Emu-Cy2nf ❑1.0
St CAeA
Miunf ConWmer AheineeusinMRepula5
HOME IMMOVEMENTCOWRACTOR Registration valid for individual use only
TYPE:LLC before ere expiration date. 0 bund return to:
�[A Re175a ion OW26 19 Othce of Consumer,5170 erd Business Reguladon
\ 1]5982 08282019 10 Park Plaae-Sure 51]0
4M RlCAN INSTALLATIONS, LLC. Boalon,MA W116
WESLEY COUTURE
130 COLLEGE STREET SUITE 100 J
SOUTH HADLEY,MA 01075 Undersecretary t Valid without signature
Ai a CERTIFICATE OF LIABILITY INSURANCE
91412GIa
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 WE PDIJCIES
BELOW. WE CERTIFICATE OF INSURANCE DOES NOT MIDI A Od I17F BETWEEN THE ISSUING INSURERI AUIWORII
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT: H 111e eerdBcate adder Is an ADDITIONAL INSURED,die poley(les)mus[be endorsed. H SUBROGATION IS WARPED,subbed W
die Name and condidmW of the pdky,certain policies maY require an aldorvamanL A s1atWMnl m this wdBcate does net ooMer rights to the
eedBeete kidder In Sou of such and
PRBUIGER Ueda 90Rere
Irabber A Oriesall jjL .lpoaeraWWebberetulgr. (413)596-0111 PA3 lunseo-§4ev
9 Nurth Kim street lgnell.com
INBUR AROI COVERAGE NAM•
Horthempton NO. 01060 IMUREAA:Xa1O1O7ar8 Hvtnel Cecaalt
INSOOD, Muess,Bereshire HYMJha,1 ODAFD Ina. 00.
Anaricen laatelletioaa, LT.0 MUM C,
Attn: Was A Suamna Ctature ..D'
130 College Street, Suits 100 INSURER E:
80Wth Healy NA OID75 INMREA F:
COVERAGES CERTIFICATE NUMSER9raseer AJ® 9-2019 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSUMNCE LISTED SELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWDHSTANDINO ANY REQUIRBAENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,WE INSURNUCE AFFORDED BY ME POUOES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHCVM MAY HAVE BEEN REDUCED BY PAID CLAIMS,
FOOL
WEIR TYPE OF MUMNCE 2111POIKY am IAIXOTPF Dem
CWMERCIALUMERALIMOTY EACHOL FENOE § 11000,000
A 8 CLOIMaMME F-100CURf 500,000
5031J1311 9/§/]Ola 9/4/]019 MFD E%P ) E 10,000
PERSONA-§AWINJURV 5 11000,000
FNl AGGREGATE TWIT AMIE$PEA: GENEIUL.FWATE § 2,000,000
E PCLICV�J DJC PRWNCI§-..OP. f 31000,000
f
AMMOMLE wBIwY 61 § 1.000.000
A ANY AM OO LVNUun`(P PENM) §
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E MIREDAVEO6 E PROP FTY DAMAGE §
AMS
i CUA FLOM E Ccna5L000 pIPHWc E 8,000
E MBM33A UAe OCCUR EAGNDCCURRENCE S 1,0001000
A PX�99 „n G.... AGGRH9ATE S 1,000 000
OEO E R 10 5/3935317 9/4/2019 9/41]019 §
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ABD EWROYERS'DAeft.
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H IWy,yFryMNFO nRC6099D 9/4/2018 9/4/3019 Lp$FASE-FA EMPLOY E 500 000
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLMAE6 BE CANCELLED BEFORE
Sl'1dBLCM OY InIma,ence WE EXPRAMN DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AURmRm8V MPM9PMATYE
W OTi.P11, CP , CIC ^'^-1��— J �,.____ 2P_J
01,88-2010 ACORD CORPORATION. All rlgMs reserved.
ACORD 2S(2014/01) The ACORD name and logo are registered me"of ACORD
INS02.51xdw0