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30C-033 (2) 137 CLEMENT ST BP-2019-1477 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:30C-033 CITY OF NORTHAMPTON Lot:-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-2019-1477 Project# JS-2019-002392 Est.Cost: S 1900.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sg.R.): 13939.20 Owner: META BOBBIE Zoning, SR(I0o Applicant: AMERICAN INSTALLATIONS LLC AT: 137 CLEMENT ST Applicant Address: Phone: Insurance. 130 COLLEGE ST (413)552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.612512019 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 OccuDancv signature: FeeTvpe: Date Paid: Amount: Building 62520190:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Iq- 6t��a3 go-l9-iy77 City of Northam It VE D D6p OR Building Depa nt ( 21Room Oto t JUN p 4 20191 ULA TION ` Northampton, M 01 phone 413-587-1240 Fax SP94 (, ate„N , ONLY ON rn 'n,M� 'S APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1-SITE INFORMATION INSULATION PERMIT 1.1 Properly Address This section to be completed by office Map c Lot rl ; -, Unit l37 Clement Street Florence,MA 01062 Zone Overlay District EIm St District CS DIew” SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record. Bobbe,Meta 137 Clement Street,Florence,MA 01062 Name tPnng CIanM MM"AEdas a: See attached Ttl"Ides" Signature 2.2 Authorized Agent American Installations 130 College Street Ste. 100, South Hadley,MA 01075 Nam\e(Prinl) Cutwa M0 Add.: ,N,y2iQ1,14� t(... Lrg,VsyL4, (413)552-0200 Signaat� TWplaro SECTION a-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed ermit applicant 1. Building $1,900.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction frau 8 3. Plunb'i g Building Permit Fee 4. Mechanical(HVAC) l.' 5.Fite Protection 6. Total•(I -2+3.4+5) 1 $1,900.00 Check Number This Section For Official Live O Building Permit Num r DataIssued: Signature: L-Zq -2019 Building Commnalanem,apeclor of Buildings Date production @ americaninstallations.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION e-CONSTRUCTION SERVICES , 8.1 Licensed Construction Sucervtaor: Not Applicable ❑ Nameof Ucanse Noldeo Wesley K. Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 9129/2019 " 'Add�\aae "" Expadbn Dive Cb&V X_ (413)552-0200 Sigmawre Telephone e.Reaistered Nome Improvement Contractor: Not Applicable O American Installations 175982 Comes"Name Regiabetion Number 130 College Street Ste. 100, South Hadley MA 01075 612612021 `Address Espimton Date W+�s4aw �L. EE1.1w�a, -Telephones (413)552-0200 SECTION 15-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25046)) Workers Compensation Insumnca affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yee....... M No...... ❑ Brief Description of Proposed Work NOTE: INSULATION ONLY Attic and basement insulation and air sealing throughout. I, American Installations- Wesley Couture as tbwnedAuthonzed Agent hereby declare that the statement and information on to foregoing application am true and accurate,to the best of my knowledge and belief. Signed under the pains and paneties of perjury. Wesley K. Couture \Pike Name 6/18/2019 Sgnalure of /Agent Dab I, Bobbe,Meta as Owner of the subject property hereby authorize American Installations to act on my behalf,in all madam relative to work authorized by this building permit application. See attached 6/18/2019 Signoras,of Owner Data City of Northampton i ,:..—.. Massachusetts V LwPARD OF aaZZMAIG IB$FECr'IOnS \ 212 Min atrot • lvSlEinq anxea.mr,eoo, iQ,cox 010 oaosq 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("NIC"). M.G.L.Chapter 142A requires that the"reconsbuction,attention, renovation,repair,modemiration,conversion, improvement,removal,demobb'on,or consauchon of an addition to anyprerxisb'ng owrreroccupied building containing at feast one but not more than low dwelling units....or to structures which are adjacent to such residence or building'be done by registered contractors. Note:Ifthe homeowner Aar contracted with a corporation or LLC,that entity must be registered Type of Work: Insulation Est.Cost: $1,900.00 Address of Work 137 Clement Street Date of Permit Application: 6/18/2019 I hereby certify that: Registration is not required fm the following reason(s): _Work excluded by law(explain): _ Job under$1,000.00 Owner obtaining own permit(explain): _Building not ovmaoc upied 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.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILTTES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of pajury: I hereby apply for a building permit as the agent of the owner: 6/18/2019 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 S ' Massachusetts A I (� D212 R Ln S OF BDI Ci la iidiftg 212 Win rtcut .a., .i 01 lvSlGinq V ti/ 'gip Northampten, MA 01060 bq � 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: 137 Clement Street, Florence,MA 01062 (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 laation or reality) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature ofPbrmit 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. ABLEli_Tr_i� � wwr.armn..+kxue.m.s.mm BBB • IkensMBlmured ® � aaa cskx:dL8118 American Installations Ma R111.11W175M2 llOCWIge NrcttkuhekW.aouM NMIry,MnOYns+UMa:OluNan 2Wran 1413155i@Vt+FinalkalMpmr(IRmerlmnlnNlhpom.mm Bobbe,Meta 2/20%2019 137 Clement a.a FbrerlM MA 01062 5129983668 NM bobbemaoc@gmail.com� I.a 919070 x.. Imm 190663 mm Quantity Unit Unit Cost w Total Air Sealing AIRSEMING 2 Innan hour $ SSW $ 110.00 Air Sealing $ 17(1.00 Air Sealing Incentive $ (110.00) Air Seeing W%Balance $ weatherbalion ATTIC DAMMING-R-38 FIBERGU 108 qft $ 2.05 $ 221.00 ATTIC FIAT-TOREN R-26 CELLULOSE 8a0 serft $ 1.38 $ 1,159.20 VENT BATH FAN THRU ROOF 1 eaN $ 118.75 $ 118.15 VENT BATH FAN THRU ROOF 1 each $ 118.75 $ 118.75 BASEMENT-INSULATE BUMHM DOOR S,INSULATE 1 each $ 110.00 $ 510.01) Total Weatherication $ 1,728.10 Weathenation lncenty $ 1,296.08 TAtalpWiert $ 1,898.10 Total UtlBty Contribu0on $ 1,166.08 Total Customer C9ntribu09n $ 132.03 W nnplNenr,11GMIIpiwla+N++lvnmba bxmmxiwxhb+l WxwMmarvMywammy. Mwatwi ImtllYrbnr.LLC kenb/OrMaf n re HmIM M maYN4 and Ybr b wmqua rbc aMn um+A wrk In+mrarnu wIM Nr++bw+apoflorlom aM tl KKN anE ahM1 bulkin ma M q+iam(mm�ar VNn a aurM b+Mn. 4CQrtanQ9F PRPnank:Re+bw.mYea.amgamoomaba TOTALCONTRACTVMUE= $ 032.03 m�dmr+rt uWM1ateryutl+rc benbyuapmd Y auNONaaro da xwXmgetlfied.vaymenwlll be La dmm prior to Down Fdymen[: j 141.00 ❑ •urtMwvk,and MYrin Neupon Compktlm, aa� Balance Due Upon Completion= $ 288.03 2/20/2019 2/20/2019 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations wi 600 Washington Street Boston,MA 02111 www.mass.gowdia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leldbly Name(B.marxrorganimlirmindwidual): American Installations,LLC Address: 130 College Street,Suite 100 City/State/Zip: South Hadley,MA 01075 Phone d: 413-552-0200 Arc you am employer?Cheek the appropriate box: Type of project(required): I.© 1 am a employer with 60 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).- have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed an the attached sheet.t T ❑ Remodeling ship and have no employees These sub-contractors have a. ❑ Demolition working for 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.❑Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL I1.❑ Plumbing repain or additions myself.[No worker'comp. c. 152.§I(4),and we have no 12.❑ Roof repairs insurance required.]r employees. [No workers 13. 1❑Other Insulation comp. insurance required.] 'Am nwlkerd dm dmels hoc#1 mml mw fill W1 the action below rhnwino iheir wokenwmpmsmion wb,y iaro,maion. I Inmeewne.who submit diu amdava hIJI-IMM They am duina all wed and 0um him wnshle eanlmem.muss submit o Inv rMil iid.1.1 ng such. :Comrttlors Ihm eMah M.box an muehed en adtlilion.I sheet shuwina lienm¢or tM wb,.l uaawa aM Iheb work,.'emerypoli,,wharmm... l am an employer lha is pmvitang workers'compensation insurance foray ernpleyeea Below is the policy and job site information Insurance Company Name: Guard Insurance Companies Policy dor Self-ins.rLLic.d: URWC6M17 _ _ Expiration Date: 09/04/2019 Job SiteAddress: ( 0' cli'meC& stsq4k Cay/staterzip: RO&AU-- ►A 61062, Attach a copy of/he workers'compensation policy declaration page(showing the policy number and expiration date). Failure m secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fins up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the fmm of a STOP WORK ORDER and a fine of up to 3250.00 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. Ida hereby certify under the pains a�nnld pens/ties of perjury thin the bribra oluar provh'ied/above is core and rnrrece S' n ASJL � l Dole' Iry1.21�19 Phone u: 413-552"0200 _1 Oficial use only. Do cast write in this area,to be cornplued by city or town off(eial City or Town: Permit/License N Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrrown Clerk 4. Electrical Inspector 5. Plumbing Impactor 6.Other Contact Person: Phone a: Commonwealth of Massachusetts Construction Supervisor 19 Division of Professional Licensure Unrestricted-Buildings of any use group which contain Board!of Building Regulations and Standards less than 36,000 cuNc feet(991 cubic owners)of enclosed Construction Supervisor space. CS-106178 Expires:09/29/2019 WESLEY COIp7URE ' 219 LATHIF REET 1 SOUTH HADLEY MA 01075 Failure to Possess a current edition of the Massachusetts State Building Cade is cause for revocation ofthis license. For information about this license COTTlziigper Call(611)]]73200 or visit www or ass.govldpl Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 175982 AMERICAN INSTALLATIONS.LLC. Eapirab.: 06/262021 130 COLLEGE STREET SURE 100 SOUTH HADLEY,MA 01075 Update Address and Return CrE. su: o ±afwi. ORica ME IMPROr AHYn TBWmss CTOR on HOMEIMPROonly TYPENTCONTAACTOR beforet the expiration ata.If al found return TYPE:LLC before the expiration data. a found to: R981atraua" Expired,=26/2021 Offic1000 of co sumerWashington S Affareef - and Business Regulation 1)5982 Ofilzfin021 Boston.MA Siraet -Suite 710 AMERICAN INSTALLATIONS.LLC. Boston.MA 02118 WESLEYCOUTURE 1 �� 130 COLLEGE STREET SUITE 100 jr/.n.+r.'[.�'.t ' SOUTH HADLEY,MA 01075 -Undersecretary �� Not valid without signature i-"N wTElwum7r7n A`OR& CERTIFICATE OF LIABILITY INSURANCE 9/4y201e 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 BEIWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N Me ce tificate hold"is an ADDITIONAL INSURED,the policy(les)must be sMemsel. N SUBROGATION IS WAIVED,Subject W the terms and conditions of the Policy,certain policies may re"Im an endoreemem. A atatament on this Ler88cate does not confer rights to the cer0ficate holder in lieu of such endo a. PROWCEs CONT yiOde PaeTa NabIlar a Grianall MNE . (413)386-0111 Uvnsel-awe 8 MOrth Sing Str.at E.NAIL .11s0aaraNlabberandEreimsell.cm LINO APFOM1epcwmaae NMeF Hortbaspton MA 01060 IMUMRA: 1 • tmtr5E1 CEE1ule fMAEO INMIRERB:Bart[abira "Wessey GUARD IAN. CO. AZerieso InetEllEtione, LLC INauRERL: Attar NEE a 9eE. Cnet. MURNI 130 Collage Street, Suit. 1DO IWUI E; soneh Radley MA 01073 Im Re F: COVERAGES CERTIFICATE NUMBERdesetee lam 9-2019 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AWIE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUOES DESCRIBED HERRN IS SUWECT TO ALL TINE TERMS EXCLUSIONS AND OOrIDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVEBEEN REDUCED BY PAID CLAIMS. WBB LWe OF00{VMXLEmKir Orin FOYCyear, LYfB CO..EMIAL GENERAL weNTY ...E1 1000,000 A Y ClAIM5 MILE �CCCUI M Ea Ee av\naece a 300,000 50]535]17 9/0/2Ola 9/4/2019 NEDIXP RMI a 10,000 PBISIX IAWIwuRV a 1,000,000 GENLAGGREGATFUNTAPRMBFER: GEIHiKAGOREGATE a 2,000,000 Y PCUCV❑,TELT ❑rte' PIpN1LTa.COLmtP AGO { 2,000,000 a AGmsONIe WBILIW a 11000,000 A ANy AIIIO BCNLY I1nVRYHM q:vn) a (g 0 Z FV7.— !A!3!]17 !/4/1010 9/4/]019 BCGLV IRA11rY1PY Y.Gon, a Y MIflm ADT Y AVT VIpPFAT —OE a Z Cql 02,0[0 Z anp52D]0 flP. 8 8,000 Y U....SAB OCNR ExMDccwlarCE a 11090,000 A EO .We I I CUIMp.rUOE AGGREGATE a 11000,000 pEp I Y I p 585555]]7 9/0/201. 9/4/]019 a NORNERB COMPDIBATION E OTX- ANO EMPLOYEBY DANrn'/ YIN ANY PROInPwBENE TNNG -PECUTIVE [-]., EL FIGN ACCmFIHT s 300 000 a IMenWbry In MO OmC609917 9/4/]010 9/4/2019 EL NBEABE-FA EMflAVE { $00,000 pESCNIPTGXIM, EL NSFA9E-PQJCY LINT 1 500,000 A COmarcial PtO y —333217 9/4/2010 9/4/2019 —SI.W] OESCM?T1DNOFOPERATONS1WCGT0N8/VEMICLE9 MCORO101,169tlau1 RenuMe SnleWla mry 0ee11e<MOMmoagaYYlg6ae CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RViaence Of Inselur Ce THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AGING.pEAE9FHTATIVE N Grinnell. CPCO. CIC L✓-'��-- �� 0IOW=14 8-2014 ACORD CORPORATION. All Nghte Ieasrvw. ACORD 25(2014101) The ACORD name and logo ere registered marks of ACORD INS026nNwn