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25C-005 (9) 128 NORTH ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1744 Map:Block:Lot:25C-005- 001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1744 PERMISSION IS HEREBY GRANTED TO: Project# Contractor: License: Est. Cost: 7700 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date:09/29/2021 Use Group: Owner: HAMP 2020,LLC Lot Size(sq.ft.) Zoning: URB Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST (413)552-0200 SOUTH HADLEY, MA 01075 ISSUED ON:08/18/2021 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATION 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. Signature: el • ' ' 1 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner DePFOR i ,,,-1. Am ,. ,,,L-j City of Northampton °,97.-1.,.., . ‘; Building Department �� ti 212 Main Street ,'1 :� ''ficy{ ��'.::_ Room 100 Street INSULATION `' ,-,ice-1 .` Northampton, MA 01060 'F,4�`�'n'1 '�'ti",lL. .�:? +`fir,�f^"r ,f4 t � ' phone 413-587-1240 Fax 413-587-1272 �'",` `' oNLrr l APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Addis This section to be completed by office /n s hr TJ t Map 25C Lot °CAC Unit p( /V ,J $J Zone oaw,oc'. Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: "/vrkA St. AL,� �/ MiG�ty A4 -11�' An �U -dtanf,o/rr►fro Diota Name(Print) f Current Mailing Address: • 305-0799- ?6 S3 See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley,MA 01075 Name(Print) Current Mailing Address: —____- - (413)552-0200 ignature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 7 7o o (a) Building Permit Fee b� o© 2. Electrical (b)Estimated Total Cost of Q Construction from(6) 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection e 6. Total=(1 +2+3+4+5) 77oo Check Number 4 7q'-el &j-v This Section For Official Use Only �/4 7 `y Date Building Permit Number: Issued: Signature: (ftinthit34-,_ Lam' se, ViVai 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 ---eilez .--- (413)552-0200 ure e 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 6/26/2023 AddressJe�� � 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 jta No 0 Brief Description of Proposed Work NOTE: INSULATION ONLY Attic and basement 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, MIc-lizy • ,~16II . ,.- ,as Ow nee 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 (p-is-o20a./ Signature of Owner tit?• City of Northampton �[HRMN� eN 1 AMassachusetts ' �.- •c� ' 4 gy: , '° DEPARTMENT OF BUILDING INSPECTIONS . f w �? 212 Main Street • Municipal Building Jsjrti Cb 1 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: 7� 700 Address of Work: l a.$ Aloe i S l r Date of Permit Application: 2-10 -a 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: - b 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 �_ �� Massachusetts F. i* ,g DEPARTMENT OF BUILDING INSPECTIONS . .x. 212 Main Street • Munici al Buildin Northampton, MA 01060 r. ..„1J MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: /A2 NQ r7`) 54 . Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner Name: /1►'c. -may M I VL't< Address: 1.2 2> A'€'r* S t City, State: /VDr 4'►'1Gt,me ft)n / 0/D to I, 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 gisaJ City of Northampton Massachusetts I �( ® c .i �s tit ;,�!-�d DEPARTMENT OF BUILDING INSPECTIONS a: 212 Main Street •Municipal Building Northampton, MA 01060 ,t,p``Y• 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: S+ Is to be disposed of at: K e'r W Materials &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) Signature of P KA0pikant 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 i mass save �censed&owned PARTNER MA cu II::tw:7a � �, MA Re56fmoortM:/5982 American Installations www.Americanlnstallations.com 130 College Street Suite 100,South Hadley,MA 01075•Office:(413)552-0200 Fax:(413)552-0202•Email:support@Americanlnstallations.com Customer Name:Mickey Miller Email:Not provided hT;Q-nt'CiC 60 1 3 el/SCV 974. >s)E — Phone:305-799-7653 Premise Address: 128 North Street,Northampton,MA 01060 Mailing Address:128 North Street,Northampton,MA 01060 Project ID:4039804 Date:Aug.3,2020 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost 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-6' Dense Pack Cellulose 1000 SF $2,490.00 $0.00 Door-2"Thermal Barrier Polyiso 1 each $90.44 $0.00 Exterior Perimeter-4'Dense Pack Cellulose 2000 SF $4,940.00 $0.00 Project Total $7,631.20 Weatherization incentive ($7,520.44) Air sealing incentive ($110.76) Total Program Incentive -$7,631.20 WARRANTY:American Ystallaticns,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American:nstaiadaos,LLC hereby proposes to furnish all material and labor to complete the above scope o`work in accordance with the above specitica;ionz and at local and state brildlng regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTA_CONTRACT VALUE_ satisfactcry and are hereby accepted.You are aphorized to do work as specified.Payment Down Payment=5 ❑ will be 1/3 down prior to start of work,and balance due upon Completion- PAID Balance Due Upon Completion- Signature //y7 // /�///1 JI //�J'�1/�1�� Date Q Property Owner(Print)'!��/t/ /'I•/-/1//E� (SrBny'� �` /r s"" Date /�a/ / Representative:(Print) (Sign) Date / PIS AtaamOMT IS COMPOSED Cr TOO PAGE AND T,E MANSE SCE CO THIS PAGE ANC SMALL SE CCNSIDER©TICE ENTIEA6REEMENT lt THE MOLES MOLDED 11SS AGAWAM 6 BETWEEN AMIEMCAM INS/ALIATCI6,LLC 1.01EEOP1pr MEMO TO AS"COAiAHY, AND:ME COST:OEMS;MOPED LAOSE,NEADAPPMA ROM=TO AS"CAW,APO WALES MOULT TOAI APPRJPRAT!LAWS,eraoalOMS ANf1 OAD MANCES OF THE StATE OP MASSACOUSET1S CR CCMELTCU1 RE?!ZTnter.AS W EJM AS ALL:DEAL%NSOI:ICMS Page 2 of 2 mass save JCerlied&ensured PARTNER CSI cst o:106173 16.111111111111 bA Reg151rCbOr,It 175982 American Installations www.Americanlnstallations.com 130 College Street Suite 100,South Hadley,MA 01075•Office:(413)552.0200 Fan:(413)552-0202•Email:support@Americanlnstallations.com Customer Name:Mickey Miller ���r 11 Email:Not provided 1'�'1tAMitKaiSefsoatt/Nr Phone:305-799-7653 Premise Address: 128 North Street,Northampton,MA 01060 Mailing Address:128 North Street,Northampton,MA 01060 Project ID:4039804 Date:Aug.3,2020 Customer Total $0.00 WARRANTY:American installations, -C will prOvide the above stated homeowner with a 1-year workmanship warranty. American'nstallations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specif ications and all local and state braiding regulation far the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE=5 satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment=S ❑ will be 1/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion- S Mickey Miller Mickey Mier(Aug 3,2020 15:57 FDT) tiyn atum Date LProperty Owner(Print) /7('rl/ ifl • ULF- (Sign)/ /y(/: / 14 Date /le/C-V Representative:(Print) (Sgn) Date 7P.15 ACISUMENTlS mi1VOSEL`01 TM PAGE MC TIE UNDUE MIX ThoPM'E.Ut SMALL GE CWssaEAED THE UR ecnWrENEwi PTht Pa$5f IWV.13 lwsnsnctutv1:56ET'WEEN*MERICAN,,STPt1ATno.i.kl EINn,ERaErwit 10I5'COM>nrr, ab TIE CtISTOYEfs;MLVCADDLL.IefENMTVI REnERREC TO AS'WEFT.ANDW:tt St SU3ACT 10A1 APPROPRIATE LAWS,MEOUTASLONS MO 000ISr.M:ES Or ME 51A7C Of r:1StAOljSETTS CR CCI.E.,,rt211 RESrizTNELT.AS WELL AS Aal LOCAL XSIS3 ViOhS The Commonwealth of Massachusetts °_ !MOM . Department of Industrial Accidents _rigI_ 1 Congress Street,Suite 100 s Boston,MA 02114-2017 www mass.gov/die. Workers'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): I.®I sin a employer with 41 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3 Q I am a homeowner doing all work myself.(No workers'comp.insurance required.]t 10 Q Building addition 4.0 lam 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 11.0 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 sub-contractors listed on the attached sheet. I3.❑ROOF repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We area corporation and its officers have exercised their right of exemption per MGL c. 14.®Other Insulation 152,J 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 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 Insurance Policy#or Self-ins.Lic.#: A�MWC187717 -� Expiration Date: 09/04/2021J Job Site Address:/ ..-.-8' /"/a1-7 L S✓/`GG� City/State/Zip/V4v- p .evi# /i /21A .a/L 4 e Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiaation date). 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. i I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. I Signature: is_y, (,p u-- Date: I Phone#: 413-552-0 00 J Official use only. Do not write in this urea,to be completed by city or town official. City or Town: Permit/License# r Issuing Authority(circle one): I 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ti Contact Person: Phone#: I I 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 Constructton Supervisor space. CS-106178 Esptres: 09129/2021 WESLEY COUTURE 139 PACKARDVILLE ROAD PELHAM MA 01002 .r+ Failure to possess a current edition of the Massachusetts D State Building Code is cause for revocation of this license. Commissioner �r ,�(/.;" For information about this license Call (617) 727-3200 or visit www.mass.gov/dpl 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: 06/26/2023 130 COLLEGE STREET SUITE 100 SOUTH HADLEY, MA 01075 Update Address and Return Card. 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 06/26/2023 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 02118 WESLEY COUTURE /4). 7 130 COLLEGE STREET SUITE 100 i,,(.4,..A',:G,'�c40.4" SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature AC ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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 EM) (413)586-0111 FA(A/X,No): (413)586-6481 8 North King Street E-MAIL leichstaedt@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: 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 ADOL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY 1,000 000 EACH OCCURRENCE $ , DAMAGE REN X CLAIMS-MADE OCCUR PREMISESO(Ea occurrence)D $ 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. GENERAL AGGREGATE $ 2,000,000 X POLICY PRO 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED •/ SCHEDULED 5Z35352 09/04/2020 09/04/2021 BODILY INJURY(Per accident) $ AUTOS ONLY /� AUTOS X HIRED X 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-MADE5J3535220 09/04/2020 09/04/2021 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? Y N/A AMWC187717 09/04/2020 09/04/2021 (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/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 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