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43-042 (2)
52 AUTUMN DR BP-2020-0318 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 43 -042 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CategM: INSULATION BUILDING PERMIT Permit# BP-2020-0318 Project# JS-2020-000533 Est. Cost: $3500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. ft.): 15246.00 Owner: REARDON ELLEN D&JAN ANNE MARIE REARDON Zoning: Applicant. AMERICAN INSTALLATIONS LLC AT: 52 AUTUMN DR Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.9/10/2019 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 9/10/2019 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Dep y Cit?of ort ampton � }sx �IdIin Dep rtment 212 ain treet INSULATION Fc 1 0 1.P t t� t�b"1_tb. Xl{3t8rt; A 01060 ;.; 1 . ,kJ`�,x;. }-,,�. ::'. phone 413-587-1240 Fax 413-587-1272 ONL APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address: �This section to be comp eted by office Map /, Lot M� Unit 52 Autumn Drive Florence,MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Reardon, Ellen &Ian-Anne 52 Autumn Drive, Florence,MA 01062 Name(Print) Current Mailing Address: See attached (41 3) 586-2560 Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: p-, K Lim- (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 $3,500.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee / 4. Mechanical(HVAC) v 5. Fire Protection 6. Total=0 +2+3+4+5) $3,500.00 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: + 6&1 SRII �d Building Commissioner/Inspector of Buildings Date production @ americaninstallations.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) c 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 9129/2021 Address Expiration Date 11111 . .(�� (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 6/26/2021 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....... W No...... ❑ Brief Description of Proposed Work NO TE: INS ULA TION ONL Y 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 _1d.1 ( 9/5/2019 Signature of Ow r/Agent Date Reardon,Ellen &Jan-Anne 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 9/5/2019 Signature of Owner Date City of Northampton �S S� Massachusetts � � J.- ''<< w: 1 . DEPARTMENT OF BUILDING INSPECTIONS b 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: $3,500.00 Address of Work: 52 Antumn Drive Date of Permit Application: 9/5/2019 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: °/5/?,n l q 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: _I -I 0j" v r(n,,;rAAA Date Owner Narrk and Signature City of Northampton ` Massachusetts t` DEPARTMENT OF BUILDING INSPECTIONS \t 212 Main Street •Municipal Building Northampton, MA 01060 sy ..• `� 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: 52 Autumn Drive (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) t1�QVIlu Kr. cj.Dab/l I Signature of Rermit 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 dcensed&Insured PARTNER MA CSI.#:2061A 1, MARegLstron017a175982 American Installations www.AmericanInstallations.com 130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)552.0200 Fax:(413)552.0202 • Email support@Americanlnstallations.com Customer Name:Ellen Reardon Email:Not provided Phone:413-586-2560 Premise Address:52 Autumn Drive,Florence,MA 01062 Mailing Address:52 Autumn Drive, Florence,MA 01062 Project ID:3879694 Date:Aug.26,2019 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 8 hr $740.64 $0.00 Rim Joist- 6" Fiberglass Batting Living Space 128 SF $345.60 $86.40 Insulation Removal Living Space 32 SF $40.32 $40.32 Attic Floor- 9" Open Blow Cellulose Living Space 1008 SF $1,834.56 $458.65 Bath Fan - Vent to Roof Living Space 1 each $141.30 $35.32 Damming Living Space 46 each $109.94 $27.48 Propavent Living Space 68 each $282.88 $70.72 Project Total $3,495.24 Weatherization incentive ($2,035.71) 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 OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRAG VALUE= 5 satisfactory and are hereby accepted.Youare authorized to dowork as specified.Payment will be 1/3 down prior to start of work,and balance due upon Completion. Down Payment=S PAID Balance Due Upon Completion=,S SigrLature Date Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date 1 NIS AGREEMENT IS COMPOSED OP THIS PAGE AND THE REVERSE SIDE Or THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT By THE PARTIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERPEO TO A5"COMPANY. AND THE CUSTOMER(S)NAMED ABOVE,HEREINAFTER R EPER RED TO AS*CLIENT".AND WILL BE SUBJECT TO ALL APPROPRUATE LAWS,REGULATIONS AND VAOMAN as OF THE STATE Of MA55ACNUSE77S OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL NRISDI CT IONS Page 2 of 2 . mass save _icensed&insured PARTNER MA C.Si p:2M)78 , MA Reglstrot,on p 175982 American Installations www.AmericanInstallations.com 130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)552.0200 Fan:(413)552.0202 A Email supportoAmericaninstallations.com Customer Name:Ellen Reardon Email:Not provided Phone:413-586-2560 Premise Address:52 Autumn Drive, Florence,MA 01062 Mailing Address:52 Autumn Drive, Florence,MA 01062 Project ID:3879694 Date:Aug.26,2019 Air sealing incentive ($740.64) Total Program Incentive -$2,776.35 Customer Total $718.89 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 theabove specifications and all local and state bolding regulations for the-otal Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRAC'VALUE=5 718.89 satisfactory and are hereby accepted.You are authorizedto do work as specified.Payment 218.00 Down Payment= SIx�x will be 1/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion- 5 500.89 8/26/2019 SignatureDate Property Owner(Print) (Sign) Date Garrett Demers Garrett Demers 8/26/2019 Representative:(Print) (Sign) Date THIS AGREEMENT IS COMPOSED Of TNIS PAGE ANO TME REVERSE SIDE OF THS PAGE AND SMALL aE CONSIDERED THE ENTIRE AGREEMENT TI THE PARTIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS'COMPANW, ANOTHE CUSTOMER(S)NAMED MOVE,HERENATER REFERRED TO AS'OLIENT,AND WAL RE SLISDECT TOALL APPROPRMTE LAWS,REGULATIONS AND ORDINANCES Of THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS W ELL AS ALL LOCAL IURISOICTIONS '\ The Commonwealth of Massachusetts Department of Industrial Accidents o I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual): 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.®I am a employer with 70 employees(full and/or part-tune).' 7. [:)New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in $, Q Remodeling any capacity.[No workers'comp.insurance required.] 9. E3 Demolition 3 Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[]Building addition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LE)Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.Q 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.Q we are a corporation and its officers have exercised their right of exemption per MCL c. 14.©Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.I *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. *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 of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their x+or'keir romp policy number I am an employer that is providing workers'cotnpensalion insurance./or my employees. Below is the policy and job site information. Insurance Company Name: Berkshire Hathaway GUARD Policy#or Self-ins.Lic.#: AMWC049875 Expiration Date: 09/04/2020 Job Site Address: )-- City/State/Zip: YAb)6L2 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expire ion date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 provided above is true and correct. I Q. Signature: _ ,_ Date: Phone#: 413-552-0 00 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.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 BUnlding Regulations and Standards less than 35,000 cubic feet (991 cubic meters) of enclosed Construction Supervisor space. CS-1 Expires: 09'19.1u1 WESLEY COUTURE 139 PACKARDVILLE ROAD PELHAM MA 01002 Failure to possess a current edition of the Massachusetts ` State Building Code is cause for revocation of this license. Commissioner For information about this license / 7 Call (617) 7273200 or visit www.mass.gov/dpi 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. SGA 1 v 20M-05/17 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: Realstration Expiration Office of Consumer Affairs and Business Regulation 175982 06/26/2021 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 02118 WESLEY COUTURE 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Undersecretary Npt valid without signature AC'_"RO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDIVVYY) Ill 8/28/2019 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(les)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 NAME: Linda Powers Webber & Grinnell PHONE (413)586-0111 AD No): 14131586-6481 8 North King Street ADDRESS: lpowers@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A:Employers Mutual Casualty INSURED INSURER B:Berkshire Hathaway GUARD Ins. Co. American Installations, LLC INSURER C: Attn: Wes & Suzanne Couture INSURER D: 130 College Street, Suite 100 INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER:Master Exp 9-2020 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. INSRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDNYYY MM DDIYYYY LIMITS COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE To RENTED A _x1 CLAIMS-MADE F1 OCCUR PREM SES Ea occurrence $ 500,000 503535217 9/4/2019 9/4/2020 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS X AUTOS 523535217 9/4/2019 9/4/2020 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS Per accident X Coll$2,000 X comp$2,000 PIP-Basic $ 8,000 X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 SJ3535217 9/4/2019 9/4/2020 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN TAT TEI ER ANY PROPRIETOR/PARTNER/EXECUTIVE El N/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? B (Mandatory in NH) AMWC994153 9/4/2019 9/4/2020 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 SA3535217 9/4/2019 9/4/2020 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(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)