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07-065 (10) 327 NORTH FARMS RD BP-2020-0638 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:07-065 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-2020-0638 Proiect# JS-2020-001080 Est.Cost: $2257.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sa.ft.): 28531.80 Owner: SKOLNIK AVY Zoning RR(100)/WSP(100)/WP(59)/ Applicant: AMERICAN INSTALLATIONS LLC AT. 327 NORTH FARMS RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.-1111512019 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: FeeTvpe: Date Paid: Amount: Building 11/15/2019 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ��� Dep �7sr� aho City of Nol- amp on (,J Building Dart entNOV 1 i 212 Main Str et 5 2019 I SULA TION Room 100 Pr of ' Northampton, M,4n �nT lSp , ah ONLY �w phone 413-587-1240 Fax 413- 2A o,oso s � 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 completed by office Map / Lot Unit 327 North Farms Road Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Avy Skolnik&Keri Dejong 327 North Farms Road Name(Print) Currerktll�a3i�ng 9A '!V44 See attached Telephone ) b Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: (413)552-0200 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2257.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) G 5. Fire Protection 6. Total=(1 + 2 +3+4+5) 00 Check Number This Section For Official Use Only Building Permit Number: Y Or �' Date Issued: Signature: Vid 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 9/29/2021 Address Expiration Date I A )P)J AJ�y . CM AtM(413)552-0200 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 6126/2021 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....... No...... ❑ Brief Description of Proposed Work NOTE: INS ULA TION 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 K uullX 11/13/2019 Signature of Owne Agent Date 1, , 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 11/13/2019 Signature of Owner Date City of Northampton Massachusetts a DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building vd,, CDS 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: 2257.00 Address of Work: 327 North Farms Road Date of Permit Application: 11/13/2019 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: 11/13/2019 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: 11/13/2019 �k)P gLA y, C,MAIO, Date Owner Name anh Signature .� City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street *municipal Building 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: 327 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: American Installations (Company Name and Address) K - cfzuh�� Signature of Flermit 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 Massachusetts L, DEPARTMENT OF BUILDING INSPECTIONS 3:, e 212 Main Street • Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 327 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: Avy Skolnik&Keri Dejong Address: 327 North Farms Road City, State: FLorence,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. Contractor signature ccndw Date 11/13/2019 Page 1 of 2 • mass save -icensed&insured PARTNER MA CS7 p:106178 , MA Reymmhon a 175982 American Installations www-Americaninstallations.com 130 College Street Suite 100,South Hadley,MA 01075•Office:(413)552.0200 Fax:(413)552.0202 A Email:support@Americaninstallations.com Customer Name:Keri Dejong Email:Not provided Phone:413-265-8344 Premise Address:327 N Farms Rd,Northampton,MA 01062 Mailing Address:327 N Farms Rd, Northampton,MA 01062 Project ID:3905565 Date:Oct.7,2019 Job Description Measure Description Location Cluantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 4 hr $370.32 $0.00 Door Sweep (with AS hrs) 3 each $75.93 $0.00 Exterior Door Weather Stripping (with AS hrs) 3 each $90.21 $0.00 Rim Joist- 2"Thermal Barrier Polyiso Living Space 152 SF $726.56 $181.64 Door-2"Thermal Barrier Polyiso Living Space 1 each $90.44 $22.61 Hatch -2"Thermal Barrier Polyiso Living Space 1 each $46.28 $11.57 Kneewall Wall -3" Fiberglass Batting Living Space 128 SF $244.48 $61.12 Kneewall Wall -2"Thermal Barrier Polyiso Living Space 128 SF $611.84 $152.96 Project Total $2,256.06 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:he 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-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 halance due upon Completion. Down Payment=S PAID Balance Our Upon Completion= S Signature Date Property Owner(Print) (Sign; Date Representative:(Print) (Sign) Date TMS AGREEMENT IS WraPOSED of THIS PAGE AND THE RELEASE S•DE Of INS PAGE AND SMALL BE CONSIDERED TME ENTA EAWEEMENT BY TME PARTIES.VOLVED TIRS AGREEMENT IS BETWEEN AMENIUN INSTALUTONS,LLC MERENNAETOT RU MEO TO AS'COMPAN r. ANCTTE CUSTOMERS)WNW W ABOVE.MENENLAFTER REFENNED 10 AVOLENT',AND WILL BE SURIEC770ALL APPROPRATE LAWS,REBULATTONS AND ORDINANCES Of TME STATE Of AA5MC MUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL NRnDICTION5 Page 2 of 2 • mass save Licensed&Insured MA C57 x:706778 , PARTNER MA RegWrorion a 175982 American Installations www.AmaricanInstallations-com 130 College Street Suite 100,South Hadley,MA 01075 A Office:(413)552-0200 Fan:(413)552-0202 R Email:support(AAmericanlnstallations.com Customer Name:Keri Dejong Email:Not provided Phone:413-265-8344 Premise Address:327 N Farms Rd,Northampton,MA 01062 Mailing Address:327 N Farms Rd,Northampton,MA 01062 Project ID:3905565 Date:Oct.7,2019 Weatherization incentive ($1,289.70) Air sealing incentive ($536.46) Total Program Incentive -$1,826.16 Customer Total $429.90 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with-he above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAu The above prices, speci`ications and conditions are 'OTA�CONTRAC-VALUE_$ 2256.06 satisfactory and are hereby accepted.you are authorized to do work as specified.Payment 143.30 ❑ will he 1/3 down prior to start of work,and balance due upon Completion. Down Payment=S 429,90 PAID Balance Due Upon Completion= s 266.60 Signature pate Oct.26,2019 Keri DeJong Oct.26,2019 Property Owner(Print) (Sign) Date Representative:(Print) (sign) Date ITIS AGREEMENT 15 COMPOSED Of TNS PAGE AND tHEREVERSE S'AE Of TNSPAGEAM SHALLaE CONSIDERED 1HE EN*IREAGIIEEMENfWT,IECMIIES INVOLVED'HIS AGREEMdn 15 BETWEEN AMERICANINS'ALLAIIONS,LLC MER MMIIX REFERRED TO AS-CJMPANY', ANETHE CJ5IOMERI51 NAMED ABOVE,HENONAFIER REFER RED TO AS-GLENS'.AND WALK SLINECT TOALL APPRCPRLATE LAWS,REGULATIONS ArID ORDNANCES Of THE 57ATE Of AMSLIDIIRETTS 09 CONr1ECTICIlT RESPECTIVELY.AS WELL AS ALL LOCAL lUMS01010NS The Commonwealth of Massachusetts Department of Industrial Accidents s 1 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 Leaibh, Name (Businessiorganization/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 hex: Type of project(required): 1.0 1 am a employer with 70 employees(full and/or part-tune)." 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in $. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.)t 10[]Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 1 I.Q Electrical repairs or additions proprietors with no employees. 12.L]Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'eomp.insurance.1 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0Other 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. 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 of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurancefor my employees. Delon,is the policy and job site information. Insurance Company Name:__Berkshlre Hathaway GUARD Policy#or Self-ins.Lic.#: AMMrWC�,0�4,[9,,875 � Expiration Date: (09/04/2020 Job Site Address:- -4 I `I O I�I 1 1 Fi A� a, Rood City/State/Zip: 1 `l��Mn, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). a� Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties of perjury that the information provided b'oiv is true and correct. Si nature: 9. Date: I 7 1 Phone#: 413-552-0 00 Official use only. Do not write in this area,to be completed by city or town official Cite 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 Massacnusetts 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. S 1 F t?a 4Kpires: 09/29/2021 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 A/�e4� •: --- For information about this license Call (617) 727-3200 or visit www.mass.gov/dpl MIX 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 O 2%1-05/17 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: Registration Eaxoiration 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 Not valid without signature ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 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 INSURERS),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 NAME: Linda Powers Webber S Grinnell PHONE Exfi (413)586-0111 AX No: (413)586-6481 8 North King Street E-MAIL ADDRESS: 1powers@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC M Northampton MA 01060 INSURERA: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 9-2020 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X PREMISES CLAIMS-MADE F1 OCCUR DAMAGETO RENTED (E....,.".) aoccurrence $ 500,000 5D3535217 9/4/2019 9/4/2020 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES 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 SZ3535217 9/4/2019 9/4/2020 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ X Coll$2,000 X comp$2,000 PIP-Basic $ 8,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION $ 10 000 5J3535217 9/4/2019 9/4/2020 1 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY x STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? E] 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 5A3535217 9/4/2019 9/4/2020 deductible$1,000 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mons 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 /f W Grinnell, CPCU, CIC ���•- ,1� -`�" ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)