Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
11-011 (7)
106 MORNINGSIDE DR BP-2021-1283 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 11 -011 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-2021-1283 Project# JS-2021-002119 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.): 30012.84 Owner: LEVERETT MONICA M Zoning: Applicant: AMERICAN INSTALLATIONS LLC AT: 106 MORNINGSIDE DR Applicant Address: Phone: Insurance: 130 COLLEGE ST#100 (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:5/3/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATIONNVEATHERIZATION 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 Signatures f • 9721(r' FeeType: Date Paid: Amount: Building 5/3/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-11272 Louis Hasbrouck—Building Commissioner DeP o¢� �. City of Northampton ?% Building Department 212 Main Street �qy AISULATION I Room 100 Northampton, MA 01060 �� .: phone 413-587-1240 Fax 413-38�7;�?�2; APPLICATION FOR INSULATION FOR A ONE OR TWO FAMIL? n1(ELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address: This section to be completed by office Map Lot ( 'l Unit /d /46rn ln9sld J)1�. /10,en�'I nn Zone Overlay District " v7 Elm St.District CB WsMet SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: RDbe-C+ + MoniC-CA Levere l /66 M'Drnl n .Side DR_ 1/orence /11i4 Name(Print) Current Mailing Addre 0/0GR See attached �/3—S —30/7 Telephone Signature 2.2 Authorized Agent: American Installations Wesley £ 4-ur-e 130 College Street Ste. 100, South Hadley, MA 01075 Name(Prin 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 3 O O (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee �7 4. Mechanical(HVAC) ✓' 5. Fire Protection 6. Total=(1 +2+3+4+5) 3r3 /�op Check Number '7�/ ?6 This Section For Official Use Only 60- 3 Date Building Permit Number: Issued: Signature: 5-3- ZOZf Building Commissioner/Inspector of Buildings Date permits@AmericanInstallations.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 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 - (413)552-0200 Sl9netur Telephone 9.Registered Home Improvement Contractor Not Applicable 0 American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 6/26/2021 Address Expiration Date V'e> 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 IS1 No 0 Brief Description of Proposed Work NOTE: INSULATION 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 SOO* oft 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 Signature of Owner Date City of Northampton • Massachusetts * DEPARTMENT OF BUILDING INSPECTIONS �', 212 Main Street • Municipal Building Northampton, MA 01060 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: 3) 3 o e Address of Work: 10(0 /'10 r r i n rt o ) err e nc e MI D Date of Permit Application: I-{-0.9-oZ 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: L(,.P.01 -a 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: Date Owner Name and Signature / City of Northampton ( Z1;� �n Massachusetts �, s. �1 . m * r w i x DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building w�5 Northampton, MA 01060 441r: 5. 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: 1 b(B I1oc Sic `1).1.-i rep t=1os_es‘rsz__ (Please print house number and street name) Is to be disposed of at: K er W Materials b Recycling, 138 Palmer Ave, West Springfield, MA 01089 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 9-029-a/ Signatire 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. City of Northampton =S`y Massachusetts t. - M s " DEPARTMENT OF BUILDING INSPECTIONS St F 212 Main Street • Municipal BuildingJ } ,�b Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 161 i I Orn Dg FI oRenCQ , Contractor <J Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner Name: /1 c'i,,Gc.,. Address: )DG /tikpfrN;n5Si4E DRi\re__ City, State: Flo -enc,e, MA 0t0Coo� 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 4;r- Date / -a 9- l The Commonwealth of Massachusetts 1`N 404111 1. Department of Industrial Accidents 71 ]� I Congress Street,Suite 100 sn . MI R"t Boston,MA 02114-2017 www.mass.gov/dia W orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly 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.[X]I a n a employer with 41 employees(full and/or pan-tune)." 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑1 am a homeowner doing all work myself[No workers'comp.insurance required.] 10 Q Building addition 4.0 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 1 l.Q Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I atn a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'cotnp.insurance.t 6.0 We are a corporation and its officers have exercisrxl their right of exemption per MGL c. 14.®Other Insulation 152,¢1(4),and we have no employees.[No workers'comp.insurance required.] "Any applicant that checks box#1 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. tContractors that check this box must attached an additional sheet showing the name or the sub-contractors and state whether or not those entities have employees. lithe 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 Insurance Policy#or Self-ins.Lic.#: AMWC187717 7 Expiration Date: 09/04/2021 Job Site Address: /a& /QI'f1Qg5ide Q/( , City/State/Zip: F1aReoe e /(V 0)01oA Attach a copy of the workers'comp.tsation policy declaration page(showing the policy number and expir)ation 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. Signature: �� uJ Date: 1//-� / -02 Phone#: 413-552-0Z00 _ 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 or Massachusetts Construction Supervisor illf Division or 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: 09/29/2021 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 ,�f�,.,�,4)/•-•�!Yr-.--- For information about this license 7 Call (617) 727-3200 or visit www.mass.gov/dpl .W;)? eariMilefeeileeed‘e/Aa4Jarwiii4W/4- 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. 4:.F.1 a 20M-05'1-, 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 02118 WESLEY COUTURE /1 //I /j ,) y 130 COLLEGE STREET SUITE 100 �/-r.4v �t��a°�i fff SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM DD YYYY) Iiiim..---- 09/21/2020 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 have ADDITIONAL INSURED provisions or 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 Eichstaedt,CRIS NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Eat): (A/C,No): 8 North King Street E-MAILDSS: leichstaedt@webberandgrinnell.com INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Employers Mutual Casualty Company 21415 INSURED INSURER B: American Installations,LLC INSURER C: AMGUARD//BHGUARD 14702 Attn:Wes&Suzanne Couture INSURER D: 130 College Street,Suite 100 INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 9-2021 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 INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,DAMAGE T000,000 RENTED X CLAIMS-MADE OCCUR PREM SESO(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A 5D3535219 09/04/2020 09/04/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000.000 X POLICY JECT PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 lEa accident) ANY AUTO BODILY INJURY(Per person) $ A - OWNED •s/ SCHEDULED 5Z35352 09/04/2020 09/04/2021 BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS XHIRED N/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /—• AUTOS ONLY (Per accident) X coll$2K X comp$2K PIP-Basic $ 8,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A - EXCESS LIAB CLAIMS-MADE 5J3535220 09/04/2020 09/04/2021 AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 500000 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA AMWC187717 09/04/2020 09/04/2021 E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 2 Customer Name: Monica Leverett Email: Not provided Phone:413-584-3017 Premise Address: 106 Morningside Drive, Florence, MA 01062 Mailing Address: 106 Morningside Drive, Florence,MA 01062 Project ID:4120444 Date: Dec.2, 2020 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 8 hr $740.64 $0.00 Door Sweep(with AS hrs) 2 each $50.62 $0.00 Exterior Door Weather Stripping (with AS hrs) 2 each $60.14 $0.00 Attic Floor-9"Open Blow Cellulose 900 SF $1,638.00 $409.50 Kneewall Wall -2"Thermal Barrier Polyiso 75 SF $358.50 $89.62 Hatch -2"Thermal Barrier Polyiso 1 each $46.28 $11.57 Damming 36 each $86.04 $21.51 Propavent 60 each $249.60 $62.40 Project Total $3,229.82 Page 2 of 2 Customer Name: Monica Leverett Email: Not provided Phone:413-584-3017 Premise Address: 106 Morningside Drive,Florence, MA 01062 Mailing Address: 106 Morningside Drive, Florence, MA 01062 Project ID:4120444 Date: Dec.2,2020 Weatherization incentive ($1,783.82) Air sealing incentive ($851.40) Total Program Incentive -$2,635.22 Customer Total $594.60 DOWN PAYMENT 150.00 PAID 12/2/20 20 Monica Jakuc Leverett Monica lakuc Leverett(Dec 2,2020 14:10 EST)