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11C-038 (3) 55 FLORENCE ST BP-2020-1019 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I IC-038 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-2020-1019 Project# JS-2020-001722 Est.Cost: $2920.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sg.ft.): 43080.84 Owner. POPPIE DAVID Zoning: URA(100) Applicant. AMERICAN INSTALLATIONS LLC AT. 55 FLORENCE ST Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.3/13/2020 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 3/13/2020 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner DepMaff City of Northampton Building Department f. f `t__J 212 Main Street ` k INSULATION i Room 100 } Northampton, MA 01060 `' '�,..; •'`^ _ phone 413-587-1240 Fax 413-587-1272 ONLYA APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULA TION PERMIT 1.1 Property Address: This section to be completed b ffice Map Lot Unit )D- Florence Street Zone Overlay District Elm St.District CS Di St.-iCi l SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: David Popple & sally imbimbo 55 Florence Street Name(Print) 1 C� er JVlail1ipp�dfl47s: See allached Telephone 1 Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: 1A )Lqj14-L. Lk (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 2920,00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee w l� 4. Mechanical (HVAC) 5. Fire Protection OL 6. Total =0 +2+3+.4+ 5) ?920.00 Check Number 49 119�1_ 0� / This Section For Official Use Only ate Building Permit Number: u �O�! / Issued: Signature: n j Z ao Building Commissioner/inspector of Buildings Date production @ americaninstallations.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 4 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 JA )P,�bJ4 �.COIJAL (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....... j$i No...... ❑ Brief Description of Proposed Work NOTE: INSULATION ONLY Attic and basement insulation and air sealing throughout. t, 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 3/6/20 Signature of Own /Agent Date I, , 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 3/6/20 Signature of Owner Date r City of Northampton Massachusetts A c DEPARTMENT OF BUILDING INSPECTIONS s ;$r 212 Main Street • Municipal Building Jb ca` Northampton, MA 01060 �s6 fY ,jC�J 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: 2920.00 Address of Work: 55 Florence Street Date of Permit Application: 3/6/20 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: 3/6/20 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: 3/6/20 IA)Vb-, L Cnfl/11 Date Owner Name Ind Signature City of Northampton Massachusetts 'A DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 01060 asbW `1`� 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: 55 Florence Street (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) t. COIAt+1L Signature of P&rmit 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 k _ Massachusetts h N DEPARTMENT OF BUILDING INSPECTIONS v. Z 212 Main Street • Municipal Building �s• Sp Northampton, MA 01060 s �1 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 55 Florence Street Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413) 552-0200 Property Owner Name: David Poppie &Sally Imbimbo Address: 55 Florence Street City, State: Leeds,MA 01053 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 Date 3/6/20 A+ www.Americaninstallations.com BBB Licensed&Insured rating mass save MA CSL#:106178 " American Installations PARTNER MA Registration#175982 130 College Street Suite 100,South Hadley,MA 01075 Office:1413)552-0200 Fax:(413)552-0202 • Email:support@Americaninstallations.com Poppie&Lmbimbo 3/4/2020 (Firs1-1) hotel 55 Florence st Leeds MA 01053 (Addre..l K-0) Isulel IaPI (413)210-4241 IP,imarrl IsKOPmrrl fEmaiil 498847 20-0626 Isle ID) Don RI Quantity Unit Unit Cost Total Air Sealing AIR SEALING 6 man hour $ 85.00 $ 510.00 WEATHERSTRIP DOOR 2 each $ 58.00 $ 116.00 DOOR SWEEP 2 each $ 25.00 $ 50.00 Total Air Sealing Value $ 676.00 Utility Air Sealing Incentive—$ (676.00) Weatherization ATTIC HATCH-SEAL&INSULATE 1 each $ 60.00 $ 60.00 WALLS-MULTI-LAYER 4"CELLULOSE 888 sgft $ 2.32 $ 2,060.16 BASEMENT SILLS-R-I9 FIBERGLASS 63 sgft $ 1.95 $ 122.85 Total Weatherization Value $ 2,243.01 Utility Weatherization Incentive $ (1,682.26) Total Project Value $ 2,919.01 Utility Weatherization/Air Sealing Incentive $ (2,358.26) Weatherization Balance $ 560.75 Total Customer Contribution $ 560.75 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 Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL:The above prices,specifications and TOTAL CONTRACT VALUE= $ 560.75 conditions are satisfactory and are hereby accepted.You are authorized to do work as specified.Payment will be 1/3 down prior to Down Payment= $ 186.00 ❑ start of work,and balance due upon Completion. PAID Balance Due Upon Completion= $ 374.75 3/4/2020 ss-2 Dale Poppie&Lmbimbo 3/4/2020 I—awoe.IPriPt) Prof"over(s,) IAte Tim Wheeler 3/4/2020 Repesemanrelamq aepeae.rtanre(slm) wte THIS AGREEMENT 15 COMP05ED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS'COMPANY',AND THE CUSTOMERIS)NAMED ABOVE,HEREINAFTER REFERRED TO AS'CUENT',AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECT NELY,AS WELL AS ALL LOCAL JURISDICTIONS. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 r www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print I eeibly Name (Business/OrganizatioNlndividual): 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): qK l am a employer with 70 employees(full andlor part-tune).* 7. []New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8, E]Remodeling any capacity.[No workers'comp.insurance required.) 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp,insurance required.]} 10[]Building addition 4.D 1 am a homeowner and will be hiring contractors to conduct all work on my property. [will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the subcontractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance t 6.E]We are a corporation and its officers have exercised their right of exemption per MGL c. 14.QX Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.I *Any applicant that checks box#1 must also fill out the section bclo%v 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 workers'comp.policy number. I am an employer that is providing workers'compensation insurance for 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: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration 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 Signature: Date: Phone#: 41 - 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/7'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Commonwealth o► Massachusetts Construction Supervisor Division of Professional Licensure Unrestricted -Buildings of any use group which contain Board of Building Regulations and Standara,, less than 35,000 cubic feet (991 cubic meters) of enclosed Construction Supervisor space. c '06178 Ecpires. 09129/2021 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 � For information about this license Call (617) 727-3200 or visit www.mass.gov/dpi e//L� �tf✓t/f�.JryE����1��%1G' t����� .{.Lti�!!ri'�2'iGC/ Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC AMERICAN INSTALLATIONS,LLC. Registration: 175982 130 COLLEGE STREET SUITE 100 Expiration: 06/26/2021 SOUTH HADLEY,MA 01075 Update Address and Return Card- SGA 1 a 2OM-05/17 Office of Consumer Affairs 8 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 02118 WESLEY COUTURE 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Undersecretary f vt valid without signature ACo CERTIFICATE OF LIABILITY INSURANCE78/28/2019 E(MM/DD/YVYY) �� 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 NAME: Linda Powers Webber & Grinnell PHONE A/C No x (413)586-0111 FAX (413)586-6481 A/C,No): 8 North King Street AIL ADDRESS 1powers@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 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 ADOL SUBR I POLICY EFF POLICY EXP LTR TYPE OF INSURANCE imqn mn POLICY NUMBER MM/DD/YYVV MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X CLAIMS-MADE �OCCUR PREMIDAMASES (Ea occurrence) ED 500,000 PREMISES Ea occurrence $ 5D3535217 9/4/2019 9/4/2020 MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY 5 11000,000 GENT AGGREGATE LIMIT APPLIES PER: PRO- GENERAL AGGREGATE $ 2,000,000 X POLICY ❑JECT - LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident AANYAUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS 1Xxx AUTOS 523535217 9/4/2019 9/4/2020 BODILY INJURY(Per accident) $ X HIREDAUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ X Coll$2,000 comp$2,000 PIP-Basic S 8,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION $ 10,000 5J3535217 9/4/2019 9/4/2020 r $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N x STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 500,000 OFFICER'MEMBER EXCLUDED? F-1 N/A B (Mandatory in NH) AMWC994153 9/4/2019 9/4/2020 E.L.DISEASE-EA EMPLOYEE $ 500,000 If ves,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/LOCATIONS/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 �yI 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)