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29-081 (6) BP-2021-2056 37 ACREBROOK DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-081-001 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-2021-2056 PERMISSIONIS HEREBY GRANTED TO: Project# 2021 INSULATION/AIR SEALING Contractor: License: Est.Cost: AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date:09/29/2023 Use Group: Owner: MANSFIELD DONNA J Lot Size (sq.ft.) Zoning: WSP Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC262555 SOUTH HADLEY, MA 01075 ISSUED ON:10/22/2021 TO PERFORM THE FOLLOWING WORK: ATIC&BASEMENT INSULATION & 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. Signature: (11: ,,9 g l Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildine Commissioner ,, r L . IN A. ^A�,f, City of Northampton ; r?�'>e '� "\� Building Department • .� 212 oat;; Street to et I NS ULA TI N �... i Northampton, MA 01060 :Y . i phone 413-587-1240 Fax 413-587-1272 rho:#r, _ 4� * APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: This section to be completed by office 39 Ffcrebrook D , Map2' —O&/'COi Lot Unit l Zone W / Overlay District rIoRenee) MA Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1.1 Owner of Record: 1 �r /� (Donna 4- Mn�yt' e'C ilAns-*,eV A_ 37 l7(.('elr'onA „Dr. i/Dif e# Name(Print) at) Current Mailing Address: i See attached Telephon17/3 5_ ^ ?/ 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 4 �b� (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of 6 Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) k fJ . 5. Fire Protection b 6. Total=(1 +2+3+4+5) 47/ 206 Check Number 121?3 This Section For Official Use Only BuildingPermit Number: Date BP-Lb21—�'� Issued: Signature: i�- Z 1 —2402 i 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 Hoiden: Wesley K. Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 9/29/2023 Address Expiration Date � ) 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 6/26/2023 Address Expiration Date Telephone (413)552-0200 Ittt- 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 0 Brief Description of Proposed Work NOTE: INSULATION ONL Y 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 ame /4-/6-e4.a/ Signature of Date I, �Q n rt iitth.gee\, as Owl*,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 -Jr' Signature of Owner Date City of Northampton QYnna,vr • Massachusetts At * c t ` . DEPARTMENT OF BUILDING INSPECTIONS lies• ' .tr 212 Main Street • Municipal Building •�titi 'Ca1 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 CHIC"). 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: 02a Address of Work:37 /gccebrov Pr.� i 7oRenca Date of Permit Application: ZO 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: JO_ 6_�0a/ 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 ram, ,i Massachusetts 4 I DEPARTMENT OF BUILDING INSPECTIONS 49. j wk` tf 212 Main Street 'Municipal Building -.'yW.t✓" Northampton, MA 01060 rsbW ,�r� 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: 3 7 Af?eJ7Coofrc �R . (Please print house number and street name) Is to be disposed of at: K er 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) /6 " / i nature o ermit 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 F' DEPARTMENT OF BUILDING INSPECTIONS ti-. 212 Main Street • Municipal Building �4s-• jCD S `1 Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: ,37 e/f`nok '. Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner,„ �C�1_ / Name: Q(l7\A �- Mitej,eue_el-E n S 1;/2 Address: 31 e Roc 1< Dr . City, State: fIoir?c..'e� 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 a? �/ The Commonwealth of Massachusetts Department of Industrial Accidents ,= 1_9 Office of Investigations '= Lafayette City Center . .s. / 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):American Installations LLC Address:130 College St, 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 43 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ri New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13.0 Other 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. :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 Insurance Policy#or Self-ins. Lic. #:AMWC262555 Expiration Date: 09/04/2022 Job Site Address: 3 7 /t L r rot, I /- f i Y G City/State/Zip:Pia f GA c 6/ 0 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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: . �,E?� Date: / CJ 2 - 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(check one): I—I 1❑Board of Health 20 Building Department 3LJCity/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: lipCommonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons x .a4111 r = Isar 4.4 CS-106178 . ' 6,ires: 09129/2423 WESLEY COUTURE ` , fit 139 PACKARDVILLE ` , PELHAM MA 1002 ,, * , ,- w 0 41/.. „ cit Commissioner rr{ K.cl e. rr .. , . ...._ __ 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: 06/262023 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: Baslatratioa EXRIiail48 Office of Consumer Affairs and Business Regulation 175982 06/26/2023 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC Boston,MA 02118 WESLEY COUTURE Z1127 130 COLLEGE STREET SUITE 100 ,(.,.,�'a s s. N01<valid signature SOUTH HADLEY,MA 01075 Undersecretary _A G® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/23/2021 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 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 Barbara Grynkiewicz NAME: Webber&Grinnell PHONE(A/C (413)586-0111 Fax (A/C,No): (413)586-6481 8 North King Street E-MAIL Extl:IL bgrynkiewicz(c�webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC C Northampton MA 01060 INSURER A: Employers Mutual Casualty Company 21415 INSURED INSURER B: AmGUARD/BH GUARD 43290 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: Exp 9/4/22 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYY) UNITS COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 DAMAGETO RENTED 500,000 CLAIMS-MADE 7OCCUR PREMISES(Ea occurrence) $ - MED EXP(Any one person) $ 10,000 A 5D3535221 09/04/2021 09/04/2022 PERSONAL&ADV INJURY $ 1,000'000 GGEEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICYFl PRO- 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A ONED X W SCHEDULED 5Z3535221 09/04/2021 09/04/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) PIP-Basic $ 8,000 X UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 5J3535221 09/04/2021 09/04/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 500,000 B ANY CER/MEMBPROPRIETOR/PARTNER/EXECUTIVE (i N/A AMWC262555 09/04/2021 09/04/2022 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY 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 r • A+ www.Americanlnstallations.com BBB Licensed&Insured R` ytp rating 1 MISS WNW MACSLN:106178 B S t'S American Installations PARTNER MA Registration#175982 130 College Street Suite 100,South Hadley,MA 01075• Office:(413)552-0200 Fax:(413)552-0202 • Email:support@IAmerlcanlnstallatlons.com Donna&Margaret Mansfield 8/25/2021 (First last) (Date) 37 Acrebrook Drive Florence MA 01062 (Address) (City) (State) (Zip) 502116 21-1361 (Sae ID) (lob a) Quantity Unit Unit Cost Total Air Sealing AIR SEALING 12 man hour $ 85.00 $ 1,020.00 DOOR SWEEP 3 each $ 25.00 $ 75.00 WEATHERSTRIP DOOR 3 each $ 58.00 $ 174.00 Total Air Sealing Value $ 1,269.00 Utility Air Sealing Incentive $ (1,269.00) Weatherization BASEMENT SILLS-R-19 FIBERGLASS 138 sqft $ 1.95 $ 269.10 ATTIC HATCH-SEAL&INSULATE 1 each $ 60.00 $ 60.00 ATTIC FLAT-10"OPEN R-37 CELLULOSE 1,212 sqft $ 1.56 $ 1,890.72 ATTIC DAMMING-R-38 FIBERGLASS 162 sqft $ 2.05 $ 332.10 VENTILATION CHUTES 88 each $ 2.50 $ 220.00 4"INSULATED HOSE ONLY 1 each $ 60.00 $ 60.00 Total Weatherization Value $ 2,831.92 Utility Weatherization Incentive $ (2,123.94) Total Project Value $ 4,100.92 Utility Weatherization/Air Sealing Incentive $ (3,392.94) Weatherization Balance $ 707.98 Total Customer Contribution $ 707.98 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= $ 707.98 conditions are satisfactory and are hereby accepted.You are Paid in full authorized to do work as specified.Payment will be 1/3 down prior Down Payment= sz60.00 un to rt of work,and balance due upon Completion. • PAID / � ��_ e Balance Due Upon Completion= 19& 507.98 Client Signature Date te Eddie Perez Al Representative Al Rep Signature Date THIS AGREEMENT IS COMPOSED 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 CUSTOMEMS)NAMED ABOVE,HEREINAFTER REFERRED TO AS'CLIENT',AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSAOIUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS. 9,1- l3( / 1alaa,