07-052 (7) 384 NORTH FARMS RD BP-2019-1434
GIS M: COMMONWEALTH OF MASSACHUSETTS
Map:Block:07-052 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category:INSULATION BUILDING PERMIT
Permit# BP-2019-1434
Proiect# JS-2019-002317
Est.Cost:$4700.00
Foe:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sa.n.): 34717.32 Owner: STRONG KENNETH A&LINDA E
Zoning: RR(100VWSP(IOOVWP(26V Applicant. AMERICAN INSTALLATIONS LLC
AT. 384 NORTH FARMS RD
Applicant Address: Phone: .Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON.6,11812019 0.00:00
TO PERFORM THE FOLLOWING WORMATTIC 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: knunutt:
Building 6/1820190:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED &,a ,y. ,y3
City of Northampton UN 1 4 2ZDNOBuilding Department
212 Main Street Dear nun dT,ON
Room 100 " TM !'7
Northampton, MA 01080
phone 413-587-1240 Fax 413-587-1272 ONLY
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION I-SITE INFORMATION INSULATION PERMIT
1.1 Property Address: This section to be completed by office
Map U ( Lot (J 5� Unit
384 North Fauns Road
Zone Overlay Dlabict
Fin St.District CS Dletriet
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Kenneth Strong 384 North Farms Road
Name(PMO CyrpB(N"80FSl1YAd r:
See attached Telep1'see, U-
2.2 Authorized Aden:
American Installations 130 College Street Ste. 100, South Hadley, MA 01075
Name(PM1ig Lulea Me"Addmu:
. CALM-I (413)552-0200
B,gnansa Tekphear
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cast(Dollars)to be Official Use Only
completed bpermit applicant
1. Building 4700.00 (a)Building Permit Fee
2. Electrical (b)Estimabd Total Cost of
Construction from 6
3. Plumbing Building Permit Fee Do
4. Mechanical(HVAC)
5.Fire Protection
S. Total=(1 .2+3«4+5) 4700.00 CherA Number _ 2,
This Section For Official Use Only
Building Permit Num be Date
ssued:
Signature:
&Adrg Genmbsierermrepeclor of Buldlgs Dm
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES '
8.1 I-ieenead Canetruction Supervisor Not Applicable ❑
N.m.mucene.xolder Wesley R. Couture 106178
Uterus Number
130 College Street Ste. 100, South Hadley MA 01075 9/29/2019
Eviration Dela
64, V. , (413)552-0200
Signature Telephone
9.Rsaistered Nome improvement Contractor. Not Applk" O
American Installations 175982
Comes"Maine Registration Number
130 College Street Ste. 100, South Hadley MA 01075 6/26/2019
Address Expiration Data
1
,A..a+,. 'iiTelephone (413)552-0200
SECTION S-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will res it
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... jQ No...... ❑
Brief Description of Proposed Work NOTE: INSULATION ONLYI
Attic and basement insulation and air sealing throughout.
I, as Owner/Authorized
Agent hereby declare that the statements and intonation on the foregoing application am true and accurate,to the beat of my knowledge
and belief.
Signed under the pains aid penalties of perjury.
Print Name
6/7/2019
Signature of Owner/Agent Over,
I, ,as Owner of the subject
property,
hereby authorize American Installations
to�a on� W
my behalf,in all matters relative mi�ve work authorized by this building permit application.IAk�` V- . WW.AlnA.. 6/5,'1119
Signal.of Ovesir Date
City of Northampton
Massachusetts
I DSPARIlIlmr OF BUILDING IIraPSCelONS p {'
212 win Str t • Hmtclpal auileing `17 aCt
North ton, M 01060
\I
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 must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renoveh'on,repair,modernization,conversion,
improvement,removal,demolition, or construction of an addition to anypre-existing owneo-occupled building containing
at least one but not more than Pour dwelling units....or to structures wNch are adjacent to such residence a building'be
done by registered contractors.
Note.Ifthe homeowner has contracted with a corporation or LLC,that entity mast be registered
Type of Work: Insulation Est. Cost: 4700M0
Address of Work 384 North Farms Road
Date of Permit Application: 6/7/2019
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•ocoupicd
z Other(spmify): 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 for a building permit as the agent of the owner:
617/2019 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:
6/7/2019
Date Owner Name and Signature
City of Northampton
Massachusetts
osPMT G8 BMIDZNG Za ECPZGNS
212 win ati«t 0I ciwl buildlnq s
Narthe tan, N 01060 i+by,,rj`0C
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:
384 North Farms Road
(Please print house number and street name)
Is to be disposed of at:
Waste Management of 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:
(Company Name and Address)
-
�.p T�K)..1� V- . co-"3 w
Signature of it 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
ppp H� Maaaachusatts L '4v
R DEPM2fIfNT OP BaZLnING INSP6CTZONS i\
*> 212010 ILin tawt • lNn euilGlnq
NorNury[on, IA 01060
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: 381 North Farms Road
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley MA
Phone: (413)552-0200
Property Owner
Name: Kenneth Strong
Address: 384 North Farms Road
City, State: Northampton,MA 01062
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.
Contra orsignao t; V t.p"X)OT �
Date 6/7/2019
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Customer Nems:Kenneth Strong
Email:Not provided
Phone:413-320-8090
Premise Address:384 N Farms Rd,Northampton,MA 01062
Mailing Address:384 N Farms Rd,Northampton,MA 01062
Project 10:3822681
Date:May 16,2019
Job Description
- - Total Customer
Measure Description Location Quantity Unit Cost Cost
Insulation Removal Living 66 SF $83.16 $83.16
Space
Rim Joist-6" Rberglass Batting Living 137 SF $369.90 $92.47
Space
Door Sweep(with AS hrs) Living 2 each $50.62 $0.00
Space
Exterior Door Weather Stripping (with AS hrs) Living 2 each $60.14 $0.00
Space
Vapor Barrier-6 mil Polyethylene with AS hrs Living 492 SF
Po lane Y Y ( ) Space $482.16 $0.00
Hatch-2'Thermal Barrier Polyiso �dCe 5 each $231.40 $57.85
Sheathing Access Living 4 each $160.08 $40.02
Space
Kneewall Wall -2"Thermal Barrier Polyiso Living 220 SF $1,051.60 $262.90
Space
Whole House Fan Box-2"Thermal Barrier Polyiso(with Living 1 each $187.70 $0.00
AS hrs) Space
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Customer Name:Kenneth Strong
Email:Not provided
Phone:413-320-8090
Premise Address:384 N Farms Rd,Northampton,MA 01062
Mailing Address:384 N Farms Rd,Northampton,MA 01062
Prefect 110,3822681
Da M"WIY g,2019 Living 32 each $76.48 $19.12
Space
Attic Floor- 6"Open Blow Cellulose Living 720 SF $1,166.40 $291.60
Space
Air Sealing at Estimated 62.5 CFM50 Per Hour Living 8 hr $740.64 $0.00
Space
Project Total $4,660.28
Weatherization incentive ($2,291.90)
Air sealing incentive ($1,521.26)
Total Program Incentive -$3,813.16
Customer Total $847.12
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Page 2 of 2
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Garr.Uemers G.Dun.
wrla .o-:lwlml Is. Ome 5/16/2019
The Commonwealth ofMassachosens,
Department of Industrial Accidents
Office of investigations
IV 600 Washington Street
Boston,MA 02111
wwwnuessgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician&fPlumbers
Applicant Information Please Print Legibly
Name(Bmiresyrorganaatinmindisidud): 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 appropriate box: Type of project(required):
I.N I am o employer with 60 4. ❑ 1 am a general contractor and 1 6. ❑ New construction
employees(full and/or part-time).- have hired the subcontractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t Z ❑Remodeling
ship and have no employees These subcontractors have S. ❑Demolition
working for me in any capacity. workeri 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 11.❑ Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.]t employees.[No workers'
comp.insurance required.] 13.®Other Insula "
'Any einem Net cheats box al most atm an ora the uxlion below slowing theirworem Mmpe viv n policy indentation.
I I brrcowmn who submit this afrWuvit mdiclling they ale doing all work and nm hire nldside wntrutors must submit u wsv landisso indicating mA.
lCoemcors Nm eMek this box ove,enacted an addimanso short showing am name orlhe nd eio moms and the.wekers com,pah,mfoanetion.
I am an employer that h providing workers'romimmingdon inearanceJormy employees Below is the policy and job sire
urldemmfan
Insurance Company Name: Guard Insurance Companies
Policy tior SeiFinsqq.LLi�ic.��N: URW7,C609917 MC �j ty _ Expiration Date:,r09/014/2019 �� (� '
Job Site Address., �Y Nor—Ih FOM 8090 City/StatNZip: I VorThfl.{�MnIV�'f� o�U1Y2
Attach a copy of the workers'compensation policy declaration page(showing the policy number and titillation date).
Failure to secure coverage ar 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 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fire
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.
[do hereby certify under Ike pennins a/n�d prnaa[iees ofperjury Ike the information provided above is true and correct
S' az /pram � ( "Nf/7—U/uL_ ne .
Phone q: 413-55 -0200
Official use only. Do ret write In this area,to be complered by city or town ofJleiul
City or Town: PermillLicense h
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector
6.Other
Contact Person: Phones:
Commonwealth of Massachusetts Construction Supervisor
Division of Professional Licensure Unrestricted-Buildings of any use group which coatain
Board of Building Regulations and Standards less than 36,000 cubic feet(991 cubic maters)ofenclused
Construction Supervisor space.
CS-106178 Expires:09129/2019
LEYCOUTUR
218 E
218 LATHROPSTREET
SOOTH HADLEY MA 01075
Fatpossess curtest edition ofthe Massachusetts
StateeBuilding
i
ding Code s cause for revocation of this 0cense.
For information about this license
CORImIS8ldnaf Call(617)7273200 or visit www.mass.gov/dpi
r'%xrairrrrrnrrraPrrtl�r aC�/�irurcuy
k
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: LLC
AMERICAN INSTALLATIONS,LLC. Regxpiraion: 175982
130 COLLEGE STREET SUITE 100 F�iratlon: 0612612019
SOUTH HADLEY,MA 01075
Update Addrfae and rattan uN. Nark reeegn for charge.
sur o aa+mm 0AyL_ El Rsn .w 0EmNoyment 11tat Card
Office of Co...,offers 8 Bus.Asgulauon
NOME IMPROVEM ENT CONTRACTOR Registration veld for individual use only
TYPE:LLC baore the expirx0an data. N Icmrd return to:
Registration Expiration Moe of Consumer Affairs and Business Regulation
�,., �^ 175982 06'26/2019 10 Park Plaza-Suite 5170
AMERICAN INSTALLATIONS,LLC. Boston,MA 02118
WESLEY COUTURE
ISO COLLEGE STREET SUITE 100 r
SOUTH HADLEY.MA 01075 tvalid without signature
'4 4Ra CERTIFICATE OF LIABILITY INSURANCE 9/4/2018 4aa1a
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: If the cwfi0cate holder Is an ADDITIONAL INSURED,the policy(lea)mad Ie erNlomm. I SUBROGATION IS WANED,we(ecl to
the Mme and conditions of the poll",cemn policka may require an mtlwaement. A statement on this ceRificale does net confar rights W the
cerd0cats holdw In lim of Such mdw s.
pepglCEp CONTACT UB,a PORaLe
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130 College Street, Suits 100 mHER E:
Booth Badley M 01075 R.R:
COVERAGES CERTIFICATENUMSER:NaXtar arp 9-2019 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSUMNCE LISTED BBCW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR ME POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REDUIREMOW,TERM OR CONATION OF MY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,ME INSURANCE AFFORDED BY ME POLICIES DESCRIBED HEREIN IS Skffl C TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCHES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
B idel]CB OF Inellra➢Ce THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH ME POLICY PROVISIONS.
AVTIORR®REPREBEMITNE
W Grinnell, CPCU, CIC
0199&2014 ACORD CORP0111 IDR All rlghts reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
IN30261m1ao11