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08-004 (4) 377 COLES MEADOW RD BP-2020-0238 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:08-004 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# , BP-2020-0238 Proiect# JS-2020-000408 Est.Cost: $2000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO.- Const. O:Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sa. ft.): 87729.84 Owner. TRAN KIM Zoning: RR(100)/RI(74)/WSP(26)/ Applicant: AMERICAN INSTALLATIONS LLC AT. 377 COLES MEADOW RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.812712019 0:00:00 TO PERFORM THE 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: 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 Si�,Yuature: FeeType: Date Paid: Amount: Building 8/27/2019 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner c Dep Gi7�+ City of Northampton 'n�__� Building Department 212 Main Street AUG 2 Room 100 6 201 I SULATION Northampton, MAo. phone 413-587-1240 Fax�1 '�� � { pNL Y T ' ON-ASA orCT NS APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DW ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address This section to be completed by office 377 Coles Meadow Road Map Lot unit Northampton, MA 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: '['ran, Kim 377 Coles Meadow Road,Northampton, MA 01060 Name(Print) C n M itn A dress: See attached ��� ) ` 0 28 Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: (jQ t4 K. �'� (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 $2,000.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 006- 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) $2,000.00 Check Number This Section For Official Use Only Date Building Permit Number Issued: Signature: -a Zo l 7 Building Commissionerlinspector 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 (413) 552-0200 Signature J Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 1 nncricafl Installations 175982 Company Name Registration Number 1,30 College Street Ste. 100, South Hadley MA 01075 6/26/2021 Address Expiration Date Telephone A 3) 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....... IS,I No...... ❑ �re Brief Description of Proposed Work 1 SIO TC: INS ULA TION ONL Y Attic insulation and air sealing throughout. 1, 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 I d 1P-v,t a 4 K. COI Ju 8/21/2019 Signature of Owner/Agent Date 1, Fran, Kim 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 8/21/2019 Signature of Owner Date City of Northampton s ✓' Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ?' 212 Main Street • Municipal Building 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: $2,000.00 Address of Work: 377 Coles Meadow Road Date of Permit Application: 8/21/2019 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: 8/21/2019 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: K. Date Owner Namd and Signature City of Northampton Massachusetts ��}" J.- DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Jy. Ca Northampton, MA 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: 377 Coles Meadow 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) Signature of Plermit 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 • mass save icensed&Insured PARTNER MA LSI p:106 178 MA Registration a 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@Americaninstallatimstom Customer Name:Kim Tran Email:k_tran5@hotmail.com Phone:509-539-0828 Premise Address:377 Coles Meadow Rd, Northampton, MA 01060 Mailing Address:377 Coles Meadow Rd, Northampton,MA 01060 Project ID:3874200 Date:Aug. 15,2019 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 6 hr $555.48 $0.00 Door Sweep (with AS hrs) Living Space 2 each $50.62 $0.00 Exterior Door Weather Stripping (with AS hrs) Living Space 2 each $60.14 $0.00 Hatch -2"Thermal Barrier Polyiso Living Space 1 each $46.28 $11.57 Attic Floor- 6"Open Blow Cellulose Living Space 644 SF $1,043.28 $260.82 Damming Living Space 74 each $176.86 $44.21 Project Total $1,932.66 Weatherization incentive ($949.82) Air sealing incentive ($666.24) Total Program Incentive -$1,616.06 Customer Total $316.60 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, sped'ications and conditions are TOTALCONTRAC—VALUE=S 5' 60 satisfactory and are hereby accepted.You are authorized to do work as specified.Payment 100.00 Down Payment=S ❑ will he 1./3 down prior to start of went,and balance due upon Completion. PAID Balance Due Upon Completion= 5 216 60 8-15-2019 y,nature Kim Tr n(Aug 19,2019) Date Tran,Kim Property Owner(Print) (Sign] Date C.Dragovich 8-15-2019 Representative:(Print} (Sign) Date IMS AGREEMENT IS COMPOSED CF TMS PAGE ANU 1HE REVERSE SIDE OF THIS VALE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT IN THE POTIES INVOLVED-HIS AGREEMENT IS BETWEEN AMERICAN INSTALIATIONS,LLC HEREINAFTER REFERRED TO AS TOMPANV-. ANOTHE LOSTOMERNS)MAMED ABOVE,HEREINAFTER REFERRED TO AS-CLIENT'.AND W ILL BE SUBJECT TOALL APPROPRIATE LAWS.REBUUTIONS AND ORDINANCES OF THE STATE Of MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS Pape 2 of 2 • mass save Licensed&insured MACS1#.7061 , %, PARTNER 78 MA Regwravon n 275982 American Installations www.AmericanInstallations.com 130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)552.0200 Fan:(413)552-0202- Emaik supportLIDAmericanlnstallations.com Customer Name:Kim Tran Email:k_tran5@hotmail.com Phone:509-539-0828 Premise Address:377 Coles Meadow Rd, Northampton, MA 01060 Mailing Address:377 Coles Meadow Rd,Northampton,MA 01060 Project ID:3874200 Date:Aug. 15,2019 Total Program Incentive -$1,616.06 Customer Total $316.60 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 the above specifications and all local and state building regulations for the-otal Contract value as stated herein. ACCEPTANCE Or PROPOSAL: The above prices, specifications and conditions are TOTALCONTRAC-VALUE=S satisfactory and are hereby accepted.You are authorized to do work as specified.Payment will be 1/3 down prior to start of work,and balance Payment=S e due upon Completion. PAID Balance Due Upon Completion= 5 Sigroture Date Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date TMS AGREEMENT IS COMPOSED OF TMS PAGE AND THERE VERSE SIDE Or TIPS PAGE AND SMALL SE CON SIDEREO TME ENTIRE AGREEMENT BY THE PM71ES INVOLVED THIS AGREEMENT IS BETWEEN AMERICAN IMF,ALIATIONS,LLC HEREINAFTER REFERRED TO AS'COMPANM, AND THE CUSTOMER(S)NAMED ABOVE,MEIIDNAFTER REFER RED TO AS'CLIENT.AND WILL BE SUBJECT TOALL APPROPRNTE LAWS,REGUUTONS AND ORDNAN02S Of THE STATE OF MASSACFLISETTS OR CONNECTICUT RESPECTIVELY,ASW ELL AS ALL LOCAL JURISDICTIONS The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ky 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiotvindividuai): 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.n I am a employer with 60 4. ❑ 1 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 on the attached sheet.t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ 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.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ 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 Insulation *Any applicant that checks box fit must also RII out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for nW employees. Below is the policy and job site information. Insurance Company Name: Guard Insurance Companies Policy#or Self-ins. Lic.M URWC609917 ,r� _ Expiration Date: 09/04/2019 _ Job Site Address: N-44,,� N-44,, t I2.� City/State/Zip:_�� 04 Q� Attach a copy of the workers'compensation policy declaration page(showing the policy number and ex iratn 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 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. 1 do hereby certify under the pains and penalties of perjury that the information provided Move is true and correct. Signature. Date: Phone#: 413-55f-0200 Oficial 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 Z. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6-Other Contact Person- Phone#: 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: 09129/2019 WESLEY COUTURE _ 218 LATHROP STREET ' 9 SOUTH HADLEY MA 01075 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. n f For information about this license Commissioner Call(617)727-3200 or visit www.mass.gov/dpi 471:1�C'yl�G��� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: LLC Registration: 175982 AMERICAN INSTALLATIONS. LLC. t 130 COLLEGE STREET SUITE 100 !"j - Expiration: 06/26/2019 SOUTH HADLEY, MA 01075 t` `•9.'t!'�L..ySj pi's Q','' Update Address and return card. Mark reason for change. SCA i •^ 201,4-05/11 n Add-=-- n 1-1 Eirpl4ys+BIIL_0!.oSt Gard a_ ��f' 1Ialt)ttI')tII:PIY�f/I I/ (II7.SNlPfJtl1F�>f' " 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 06,126/2019 10 Park Plaza-Suite 5170 AMERICAN INSTALLATIONS,LLC- Boston,MA 02116 WESLEY COUTURE 130 COLLEGE STREET SUITE 1C0 �) SOUTH HADLEY,MA 01075 Undersecretary valid without signature Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) Ill 1 9/4/2018 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 CONTACT Linda Powers NAME Webber & Grinnell PHON�9Enq (413)586-0111 EACX. .f413Msee-e4e1 8 North King Street IN ,AMAML $:lpowers@webberandgrinnel1.com --_ - ------ INSURER(§)AFFORDING COVERAGE NAIC✓t _ Northampton __ -. MA 01060 INSURER A: l rta Mutual Casualty INSURED INSURER B:Berkshire Hathaway GUARD Ins. Co. American Installations, LLC INSURERC: Attn: Wee & 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, EXCLUSION_S AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - ADDL SUBR POLICY EFF POLICY EXP LTA TYPE OF INSURANCE INSD WVQ POLICY NUMBER iMWDDIYYYXL (MMilYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE § 1,000,000 A X CLAIMS•MADE OCCUR DAMAGE TO RENTED 500,000 PREMISES Ea occurrence $ 5D3535217 9/4/2018 9/4/2019 MED EXP(Arty one person) $ 10,000 PERSONAL$ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO F7LOC 2,000,000 JECT PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY EOMBICNdED SINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS X AUTOS 523535217 9/4/2018 9/4/2019 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS P X Coll 52.000 X comp52,000 PIP-Basic $ 8,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR HCLAIMS-MADEGGREGATEA $ 1,000,090 DED X RETENTIONS 10,000 5J3535217 9/4/2018 9/4/2019 $ WORKERS COMPENSATION I PER 11- AND EMPLOYERS'LIABILITY Y/N X TA F ANY PROPR ETOR/PARTNERE.L.EACH ACCIDENT $ 500,0 rEXECUTIVE 00 OFFICER/MEMBER EXCLUDED? ❑N/A B (Mandatory In NH) URWC609917 9/4/2018 9/4/2019 E.L.DISEASE-EJB EMPLOYEE $ _ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 A j Commercial Property SA3535217 9/4/2018 9/4/2019 deductible$1,0D0 I 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 I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �W Grinnell, CPCU, CIC fly-- `� Y� ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 i2014W)