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23D-006 (2) BP-2022-0293 8l RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 22D-006-001 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-2022-0293 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 3100 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date:09/29/2023 Use Group: Owner: ASHMAN SUSAN C Lot Size (sq.ft.) Zoning: WSP Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 13000LLEGE ST SUITE 100 (413)552-0200 AMWC262555 SOUTH HADLEY, MA 01075 ISSUED ON:03/24/2022 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature:g 1 T► 0 • V • >2 . Fees Paid: S65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 0 City of Northampton Dep� I Building Department 212 Mam OStreet INS ULA TION j, Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 QJtJ( , Y 1 :f.�L APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT This section to be completed by office 1.1 Property Address: I tQ a Q J Map L O Lot Unit Zone Overlay District �l oRena AAA Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Susan le-Sk n * &wen LDCKe--- ‘73'l Kyq., Rom( /</t r,C ,Lt' Name(Print) Current Mailing Address': See attached 203 - g g � 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 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3 1 O (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of 0 Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection D U (C/� 6. Total=(1 +2+3+4+5) 3 /b()a Check Number C -1 This Section For Official Use Only Building Permit Number: Di 3 DateIssued: Signature: //1��! 3-Z`"/- O z z 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 ❑ Name of License Holder: Wesley K Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 9/29/2023 Address Expiration Date (413)552-0200 �ure 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 Address Expiration Date 4; 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 St No 0 Brief Description of Proposed Work NOTE:O TE: 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 Signature of Agent Date (5054 t A5Arlitan , 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 - a —07 Q, Signature of Owner Date City of Northampton Massachusetts �: * -c ea: et ': DEPARTMENT OF BUILDING INSPECTIONS �, 1•i �� 212 Main Street • Municipal Building Jb �a per. Northampton, MA 01060 rsb jy • �t1� 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: .3 ( 0 0 Address of Work: <I (yq C F. a reAn. CA- } Date of Permit Application: 3- a, I "?-D, 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 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 * • ='t � ti ' y DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 01060 'fr 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 1 50A. The debris from construction work being performed at: (Please printtiouse 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) Signature of 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 h sf , Massachusetts w�+ � c it t ''� N' ~ DEPARTMENT OF BUILDING INSPECTIONS yv b 212 Main Street • Municipal Building \,r^" Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 'I g yG n 1� rio ken cA Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA _ Phone: (413)552-0200 Property Owner [/ / Name: 5v5avi ,n AIrt.a (u.vi ,�n LJ e.... Address: g I Ryan iqri City, State: `o r?GhC- / O/D doo� 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 44 Date 2 � J ORa American Installations Home Performance Contractor 130 College Street,South Hadley,MA 01075 CONTRACT VVZ American Installations 413-552-0200 FAX 413-552-0202 Page 1 • PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# WORK ORDER Susan Ashman d- Gwe✓) L,oc.14)0-- (413) 887-8255 03/02/2022 341878 68603 SERVICE STREET BILLING STREET PROPOSED BY: 81 Ryan Road 81 Ryan Road American Installations SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures, Eversource is offering an incentive of 75%for insulation measures and 100%for the air sealing measures, both with no limit. You are eligible to apply for the 0% Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. HOME AIR SEALING 8 $680.00 $680.00 Provide labor and materials to seal areas of your home against wasteful, excess air leakage. Materials to be used to seal your home can include caulks, foams and other products. Primary areas for sealing include air leakage to attics, basements, attached garages and other unheated areas(windows are not generally addressed.) WEATHERSTRIP DOOR 3 $174.00 $174.00 Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOORSWEEP 6 $150.00 $150.00 Provide labor and materials to install a doorsweep to restrict air leakage. ATTIC DAMMING-R-38 FIBERGLASS 164 $336.20 $252.15 $84.05 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT-9"OPEN R-33 CELLULOSE 600 $900.00 $675.00 $225.00 Provide labor and materials to install a 9"layer of R-33 Class Cellulose added to open attic space. PULL DOWN STAIR-THERMADOME 1 $230.19 $172.64 $57.55 Provide labor and materials to install an easily moved, insulating cover for the attic access folding stair. The cover has integral weather- stripping to restrict air leakage. WHOLE HOUSE FAN COVER 1 $209.21 $156.91 $52.30 Provide labor and materials to fabricate and install a rigid foam insulating cover for the whole house fan. COMMON WALL RIGID BOARD 70 $277.20 $207.90 $69.30 Provide labor and materials to install 2"FSK faced semi-rigid fiberglass board insulation to a common wall area. as - (p-al.aa American Installations Home Performance Contractor • 130 College Street,South Hadley,MA 01075 CONTRACT - VVZ American Installations 413-552-0200 FAX 413-552-0202 Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT II WORK ORDER Susan Ashman (413) 887-8255 03/02/2022 341878 68603 SERVICE STREET BILLING STREET PROPOSED BY: 81 Ryan Road 81 Ryan Road American Installations SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL INSULATE BULKHEAD DOOR 1 $110.00 $82.50 $27.50 Provide labor and materials to insulate the back of the door to the basement's bulkhead with rigid board at R-10 or greater with the required fire rating and seal the door's edge with weatherstripping to restrict air leakage. Total: $3,066.80 Program Incentive: $2,551.10 Customer Total: $515.70 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred Fifteen & 70/100 Dollars $515.70 COMPANY REPRESENTATIVE CUST S A URE 3/222 NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE _ SIGN DATE DAYS. The Commonwealth of Massachusetts Department of Industrial Accidents S cl; Office of Investigations vas Lafayette City Center MIL MI / 2 Avenue de Lafayette, Boston, MA 02111-1750 •' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):American Installations LLC Address:130 College St, Suite 100 City/State/Zip:South Hadley, MA 01075 Phone #:413-552-0200 Are you an employer? Check the appropriate box: Type of project(required): 1. ■❑ I am a employer with 43 4. ❑ I am a general contractor and I 6. El New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its l0.0 Electrical repairs or additions 3.El I am a homeowner doing all work officers have exercised their 11.❑ 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.] *My 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: City/State,z, 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. I Si ature: Date: 3 - / ' ";-"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): 10Board of Health 20 Building Department 3.0City/Town Clerk 4.0 Electrical Inspector 5EIPlumbing Inspector 6.0Other Contact Person: Phone#: Commonwealth of Massachusetts 1/111 Division of Professional Licensure Board of Building Regulations and Standards Cons ' ' isor .1 CS-106178 NEApires: 09/29/2023 40- WESLEY COUTURE ' ' .. ,,,,' 139 PACKAROVILLE RU , :; PELHAM MA Q1002 .! r 416._c) #, 0f ' i()"'w"- M. f Commissioner da#2, f . `i i , , _ _ 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: 06262023 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Return Card. OMlos of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Beghiltaiati Ezaicallen Office of Consumer Affairs and Business Regulation 175982 06/26/2023 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 02118 r WESLEY COUTURE A/ ---- ,,� A' C � 130 COLLEGE STREET SUITE 100 f,(.�•.'a i sGG..k- Not valid without signature SOUTH HADLEY,MA 01075 Undersecretary AC D MI CERTIFICATE OF LIABILITY INSURANCE DATE 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(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 Barbara Grynkiewicz NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 c(A/C No,FxU; (A/C,No): 8 North King Street E-MAIL bgrynkiewicz@webberandgrinnell.com rinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC I/ 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. ILTR TYPE OF INSURANCE ADM SUBR POLICY EFF POLICY EXP INSD WVD POLICY NUMBER (MMIDDNYYY) (MM/DD/YYYY) UMITS COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A 5D3535221 09/04/2021 09/04/2022 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000'1100 POLICY JIECT n LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED X 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 UAB CLAIMS MADE 5J3535221 09/04/2021 09/04/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION %we(PER OTH- AND EMPLOYERS'LIABILITY ^I STATUTE ER IY�/N 500,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE I I N/A AMWC262555 09/04/2021 09/04/2022 E.L.EACH ACCIDENT $ (Mandatory inN OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I 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. 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