Loading...
17D-042 (2) 50 STRAW AVE BP-2020-0222 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D-042 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CategoU: INSULATION BUILDING PERMIT Permit# BP-2020-0222 Proiect# JS-2020-000367 Est.Cost:$3300.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. ft.): 7579.44 Owner: PUCHALSKY RICHARD J&SHERRI Zoning:URB(100)/ Applicant. AMERICAN INSTALLATIONS LLC AT. 50 STRAW AVE Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.8/22/2019 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 8/22/2019 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ~i7�r City of Northampton -7 Building DepartmentqUG SULA TION 212 Main Street 6602 7 20 7 i, I , Room 1001-'T �s SN K r Northampton, MA 01 ;v 'Ily l� phone 413-587-1240 Fax 413-5y ' a ONLY r APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: This section to be completed by office MapOV Lot Unit 50 Straw Avenue Florence, MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Puchalsky, Richard&Sherri 50 Straw Avenue,Florence,MA 01062 Name(Print) Current Mailing Address: See attached (413) 586-2516 Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: 1A)QU l m - ccfl X&'►1 (413) 552-0200 Signature j Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $3,300.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) $3,300.00 Check Number KLU This Section For Official Use Only Date Building Permit Number: Issued: Signature: (J- 21-Zo) / Building Commissioner/Inspector of Buildings Date production @ americaninstallations.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Wesley K. Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 9/29/2019 Address Expiration Date WDALkAe K. CDLALAA (413) 552-0200 Signature J Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 612612021 Address Expiration Date Telephone (413) 552-0200 SECTION 5-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(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....... JV No...... ❑ Brief Description of Proposed Work NOTE: INSULATION ONLY Attic and basement insulation and air sealing throughout. I, American Installations- Wesley Couture as Owner/Authorized Agent hereby declare that the statements and information on 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 1.1� /� QMJ,lei K. l_.f •_V_ i,� 8/19/2019 Signature of Ovukr/Agent Date I, Puchalsky, Richard&Sherri as Owner of the subject property hereby authorize American Installations to act on my behalf, in all matters relative to work authorized by this building permit application. See attached 8/19/2019 Signature of Owner Date City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS �' x ro 212 Main Street • Municipal Building `Y Northampton, MA 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:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Insulation Est.Cost: $3,300.00 Address of Work: 50 Straw Avenue Date of Permit Application: 8/19/2019 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 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: 8/19/2019 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: Iq Date Owner Nahie and Signature City of Northampton Massachusetts ��? ., •G DEPARTMENT OF BUILDING INSPECTIONS 212 Main street •Municipal Building r Northampton, MA 01060 sry .• �0 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: 50 Straw Avenue (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) WIDIU,u K . C Signature of.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. Page 1 of 2 • 1 • mass save censed&insured PARTNER MA CS1 p.106178 ` MA Regetmhon#175982 American Installations www.AmericanInstallations.com 130 College Street Suite 100,South Hadley,MA 01075• Office:(413)552.0200 Fax:(413)552.0202• Email support@Americaninstallations.com Customer Name: Richard Puchalsky Email:Not provided Phone:413-586-2516 Premise Address:50 Straw Ave,Northampton,MA 01062 Mailing Address:50 Straw Ave,Northampton,MA 01062 Project ID:3872896 Date:Aug. 14,2019 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 4 hr $370.32 $0.00 Exterior Door Weather Stripping (with AS hrs) Living Space 2 each $60.14 $0.00 Door Sweep (with AS hrs) Living Space 2 each $50.62 $0.00 Rim Joist- 6" Fiberglass Batting Living Space 56 SF $151.20 $37.80 Hatch - 2"Thermal Barrier Polyiso Living Space 1 each $46.28 $11.57 Attic Floor- 6"Open Blow Cellulose Living Space 228 SF $369.36 $92.34 Cut and Finish Access Living Space 2 each $249.06 $62.26 Damming Living Space 24 each $57.36 $14.34 Kneewall Slope - 6" Fiberglass Batting Living Space 251 SF $534.63 $133.66 Kneewall Wall -2" Thermal Barrier Polyiso Living Space 251 SF $1,199.78 $299.95 WARRANTY:American installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to completethe above scope of work in accordance with-he above specifications and all local and state building regulations for the-otal Contract value as stated herein. ACCEPTANCE O% PROPOSA,_: -he above prices, speci`icaticns and conditions are TOTAL CONTRAC'VALUE-S satisfactory and are hereby accepted.You are aurthorized to do work as specified.Payment Down Payment= S ❑ will be 1/3 down prior to start Of work,and balarce due upon Completion. PAID Balance Due Upon Completion= 5 Signature Date Property Owner(Print) (Sign; Date Representative:(Print) (Sign) Date THIS AGREEMENT$5 COMPOSED Of THIS PAGE AND THE REVERSE SIDE O THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED'HIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS'COMPANY', AND THE CUSTOMER(S)NAMM ABOVE,HERDINAFTER REFERRED TO AS-CLIEFI AND WILL SE SURTECT TO ALLAPPROPNUSTE LAWS,AMU NATIONS AND OROwAYCES OF THE STATE OF MASSACHUSETTS ON CONNECTKUT RESPECTIVELY,AS WELLAS ALL LOCAL JURISDICTIONS Page 2 of 2 4 mass save -icensed&insured PARTNER MACS, .2Dfi278 , A`: MA Regrstrot,on#275982 American Installations www.AmericanInstallations.com 130 College Street Suite 100,South Hadley,MA 01D75 • Office:(413)552-0200 rax:(413)552-0202• Email support@Americanlnstallations.corn Customer Name:Richard Puchalsky Email:Not provided Phone:413-586-2516 Premise Address:50 Straw Ave,Northampton,MA 01062 Mailing Address:50 Straw Ave,Northampton,MA 01062 Project ID:3872896 Date:Aug. 14,2019 Insulation Removal Living Space 50 SF $63.00 $63.00 Sheathing Access Living Space 3 each $120.06 $30.01 Project Total $3,271.81 Weatherization incentive ($2,045.80) Air sealing incentive ($481.08) Total Program Incentive -$2,526.88 Customer Total $744.93 WARRANTY:American installations,LLC will provide the above stated homeowner with a 1-year Workmanship warranty. American installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the-otal Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, speci`ications and conditions are TOTAL CONTRAC-VALUE= 5 744.93 satisfactory and are hereby accepted.You are authorieedtodowork asspecified.Payment 22500 8_14_20 = 5 19 will be 1 , Down Payment ® ./3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion= $ 519.93 Signature Date 8-14-2019 19-2372 Puchalsk Richard&Shcrri8-14-2019 8-14-2019 Property Owner(Print) y' twgril Date Representative:(Print) Ken Vautrin Jr. (Sign) ,f~-„ �.,,i,;,,�,, Date 8-14-2019 THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIOE Of THIS PAGE AND SHALL RE CONSIDERED THE ENTIRE AGREEMENT P THE PARTIES INVOVED THIS AGREEMENT 15 BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS'COMPANY', AMC THE CUSTOMERIS)NAMED ABOVE,HEREINAFTER REFER RED TO AS`OLIENT-,AND WILL BE SUBIECT TOALL APPROPRIATE LAWS,R[GUUTIONS AN D OROINANIES OF ME STATE Of MASSA QIUSETTS OR CONNECTICUT RESPECTIVELN,AS WELL AS ALL LOCAL IU RISDICIION5 The Commonwealth of Massachusetts = Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le0blY Business/Organization Name: 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: Business Type(required): 1.❑✓ I am a employer with 67 employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp.insurance required] g• E]Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑ Manufacturing no employees. [No workers'comp. insurance required]* 11.[—] Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.❑✓ Other Insulation *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: Guard Insurance Companies Insurer's Address: P.O. Box A-H, 16 S. River Street City/State/Zip: Wilkes-Barre, PA 18703-0020 Policy#or Self-ins.Lic.# AMWC994153 Expiration Date: 09/04/2019 Attach a copy of the 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 fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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. I do hereby certify,under the pains and penalties of perjury that the information provide above is true and correct. Si nature: 1 Date: Phone#: 413-55 -020 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia 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 Construction Supervisor space. CS-106178 Expires: 09/29/2019 WESLEY COUTURE _ 218 LATHROPSTREET SOUTH HADLEY MA 01075 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Commissioner " Call(617)727-3200 or visit www.mass.gov/dpi �.��<' JG'�/l?.f72�%I.t!l'4�Q:/,r!/Z• (,�i'//(�Q,r1r1l�C�/000r16!�fJ 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. Expiration: 06/26/2021 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Return Card. SCA 1 0 2OM•05117 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 175982 06/26/2021 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 021/18 WESLEY COUTURE j I / 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature A� CERTIFICATE OF LIABILITY INSURANCE FDA4�B�DDNY Y) 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 certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Linda Powers NAME: Webber & Grinnell PHONE (413)586-0111 'C' /C NO: (413)586-6481 8 North King Street E-MAIL ADDRESS: 1powers@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC k Northampton MA 01060 INSURER A:Employers Mutual Casualty INSURED INSURER B:Berkshire Hathaway GUARD Ins. Co. American Installations, LLC INSURERC: Attn: Wes & Suzanne Couture INSURER D: 130 College Street, Suite 100 INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER:Master Exp 9-2019 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X PREMISESS E.CLAIMS-MADE 7 OCCUR DAMAGE ( ED $ 500,000 Ea occurrence 5D3535217 9/4/2018 9/4/2019 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 X POLICY a E LOC 2,000,000JT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A ANYAUTO BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED 5Z3535217 9/4/2018 9/4/2019 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident $ X Coll$2,000 X comp$2,000 PIP-Basic $ 8,000 X UMBRELLALIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,0001 ISJ3535217 9/4/2018 9/4/2019 $ WORKERS COMPENSATION X PER ' TH- AND EMPLOYERS'LIABILITY Y/N STATUTE Ell ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 ❑ OFFICER/MEMBER EXCLUDED? NIA B (Mandatory in NH) AMWC994153 9/4/2018 9/4/2019 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Business Personal Property 5A3535217 9/4/2018 9/4/2019 deductible$1,000 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE W Grinnell, CPCU, CIC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401)