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10B-101 BPI-2022-1397 122 AUDUBON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 10B-101-001 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-2022-1397 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 6020 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date: 09/29/2023 Use Group: Owner: LUCE LORINDA A Lot Size (sq.ft.) Zoning: RR Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC262555 SOUTH HADLEY, MA 01075 ISSUED ON: 10/28/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATI ON 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VI ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Q • r . > - 5.17 Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVED i 22-2423 8' u is 'get Dep --- City of Northa ptoh >` r "A Building Depa mert OCT 2 3 2C? tt -4 212 Main St eet INSULATION , :' !l�� k Room 10 f ,'.tt: :,, D J;,j OF BUIWING INSP=CTIONS Northampton, M 01 LOIIU'��1THAMT'TON,Mn.�cisa *- phone 413-587-1240 Fax 413-587-1272 Qf/ , Y : , _ , APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: Tks section to be/c'ompleted by office 122 Audubon Rd Map w"/r/, L"Lot ' / Unit Leeds MA 01053 Zone Overlay District Elm St.District CB District SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Lorinda Luce 122 Audubon Rd Name(Print) Current Maili49g;Addresso09 i See attached Telephone hL 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 6020.46 (a)Building Permit Fee 2. Electrical 0 (b) Estimated Total Cost of Construction from(6) 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) 0 tK 5. Fire Protection 6. Total=(1 +2+3+4+ 5) 6020.46 Check Number a7 V /�/� This Section For Official Use Only Building Permit Number: '�/r ? 7'Og 7 Date /*/& Issued:9Si nature: Iel-28-ZOz 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 0 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 ' nature 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 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 ja No 0 Brief Description of Proposed Work NOTE: INSULATION ONLY 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 10/19/22 Signature of O M V Agent Date I, Lorinda Luce , 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 10/12/22 Signature of Owner Date City of Northampton 5�5 Sic, ,.,4 Massachusetts F -4'. '<<. 1 0 ft' DEPARTMENT OF BUILDING INSPECTIONS �, r . : 212 Main Street • Municipal Building �Jy ca `< • •,tea' Northampton, MA 01060 bh, . \��� 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: 6020.46 Address of Work: 122 Audubon Road Date of Permit Application: 10/19/22 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: 10/19/22 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 pp' Al.,;' $ s '''', Massachusetts �4�'�� .. ��,, i ,'44 y ;,', + 0's DEPARTMENT OF BUILDING INSPECTIONS a-1.. tif g'- n. 4 212 Main Street •Municipal Building 'i. ti y N.;�,,.TY, ""`" Northampton, MA 01060 bW l�� 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: 122 Audubon Rd (Please print house number and street name) Is to be disposed of at: K& 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) Ze:e:/,(4kt-:--- 10/19/22 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 S:5 'Si , Massachusetts �, c tz; k, =` Ei 4i` DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building `.. Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 122 Audubon Rd Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner Name: Lorinda Luce Address: 122 Audubon Rd City, State: Leeds MA 01053 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 10/19/22 Customer Name:Lorinda Luce Email:Not provided Phone:413-627-0091 Premise Address:122 Audubon Rd, Leeds,MA 01053 Mailing Address: 122 Audubon Rd,Northampton,MA 01053 Project ID:4577591 Date:Aug.31,2022 Job Description Measure Description Location.,. Quantity. Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Other 4 hr $377.32 $0.00 Door Sweep (with AS hrs) Other 4 each $104.44 $0.00 Exterior Door Weather Stripping (with AS hrs) Other 4 each $127.24 $0.00 Rim Joist- 2" Thermal Barrier Polyiso Other 60 SF $292.20 $73.05 Walls - Wood Shingle -4'I Dense Pack Cellulose Other 414 SF $1,022.58 $ 55.64 Attic Floor - 8" Dense Pack Cellulose Other 600 SF $1,698.00 $ 24.50 Open Wall - 2"Thermal Barrier Polyiso Other 360 SF $1,746.00 $436.52 Door- 2'I Thermal Barrier Polyiso Other 1 each $90.61 $22.65 Attic Floor - 13"Open Blow Cellulose Other 180 SF $423.00 $105.75 Damming Other 26 each $63.70 $15.92 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 conditions are TOTAL CONTRACT VALUE a satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment-S ❑ will be I/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion a 5 Signature Date Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date 1F.IS AGREEMENT IS CDMPOSWD OF 1MS PAGE ANO 1HE REVERSE S'OE Or THIS PAGE AND SHALL EE cON110ERLD 1HE ENT IRE AGRLEMEMT Er 1HE Patio IHVOWED.111IE AGREEMEM/IS ECM EN AMERICAN INSIALIATONS,uc ILEREINNTUI RERDEIED lO AS-COMPANY, AM1'O1ME CutrOMrfISI NAMED Arove,MtrrrAP iN REf EARE010 AS'0 5vr.ANO WILL IC SUAIECT TO All APPAOPPLA1E LAWS,REGULATONS MO OROVrancLS Of THE STATE Of MASSACHUSCTIS OR CONNLCTICUE REAP ECIM LE.AS era Al AU LOCAL IURISOIC1 LONS. Page 2 of 2 mass save licensed&Insured PARTNER MA SRN:106178 MA Registration a 175982 American Installations www.Americanlnstallatlons.com 130 College Street Suite 100,South Harley,MA 01075•Office:(413)552.0200 Fall:(413)552.0202 • Email:supporteAmericannstallations.com Customer Name:Lorinda Luce Email:Not provided Phone:413-627-0091 Premise Address:122 Audubon Rd,Leeds,MA 01053 Mailing Address:122 Audubon Rd,Northampton,MA 01053 Project ID:4577591 Date:Aug.31,2022 Bath Fan Hose Other 1 each $28.00 $7.00 Hatch -211 Thermal Barrier Polyiso Other 1 each $47.37 $11.84 Project Total $6,020.46 Weatherization incentive 44,058.59) Air sealing incentive ($609.00) Total Program Incentive -$4,667.59 Customer Total $1,352.87 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American InstaNations,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 Sate bulling regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE=S satisfactory and are hereby accepted.You are authorized to do work as specified Payment Down Payment.S Due 400.00 ❑ will be 1/3 down prior to start of work,and balance due upon Completion. - PA Balance Due Upon Completion a S 41 • ��dQ-- .j; '' -- Dote �0 oZ Property Owner(Pr nt) (Sign) Date Representative:(Print) �� ��-� (Sign) Date TNT AORErMa1T A COMPOSED OF THIS PAGE AND THE RWISE SQL Li THIS PADS ARO SHALL SE CO4510E IEO THE ENI IRE AGREEMENT a1 THE PARTIES INVOK0.1 NIS AGREEMENT IS ao WIEN AMERICAN INST4lATIONS,LLC NOUN ATTER errcwep 1O AS'COMPANY', Mang CUSTOMERIS)MATEO MOVE,HERONAET ER RETERRED10 AS'WENT.,AND Will OE SUl1ECT 10 ALL MPROPRIATE LAWS,RECKAATlONS ANO MIN VMSOT THE STATE OF MASSAOIUSET TS OR CONNECTKUT RESPECTWELY.AS WEU.AS ALL KCAL AMISCN MICAS. I he Commonwealth of Massachusetts Department of Industrial Accidents ...;+ 1l Office of Investigations Lafayette City Center `. 2 Avenue de Lafayette, Boston,MA 02111-1750 '•w.,; WWW.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):American Installations L LC 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): 1.0 I am a employer with 43 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ['New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in anycapacity. employees and have workers' P h' 9. ❑Building addition [No workers' comp.insurance comp.insurance.: 10.0 Electrical repairs or additi ns required.] 5. 0 We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additi ns 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.�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. 1 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. mAMWC332951 Expiration Date:OW04/2023 Job Site Address: 122 Audubon Rd City/State/Zip: Leeds MA 01053 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 fme 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: 9, 6,... ...._ Date: 10/19/22 Phone#: 413-552-0?Strt411— p 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): 112Board of Health 20 Building Department laity/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.1:Other Contact Person: Phone#: , , ppk-::fr,-4-n'pr,,,n7:Fwp7SF Commonwealth of Massachusetts ) Division of Professional Licensure zoard of Building Regulations and Standards , - 1 bliitti Cons . , i- flitrvisor -,. CS-106178 _ .. E .iptcres: 09/29/2023 WESLEY COUTURE ... 139 PACICARI)VILLE ROAk ,_..... PELHAM MA 01002 --- ,,,,o ‘"t's ii•,": ,,ot -be ' .0'( )/is\ i f:.1 , -. „ . , Commissiorter (::-A .4-.. 11, tiColcithx_„ it9 , . . • _ ____ __ _ Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: U...0 Registration: 175932 AMERICAN INSTALLATIONS,LLC. Expiration: 06/26/2023 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Re i Card. Office of Conountor Affairs&Business RogolotIon HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. if found return to: haalatutian - ration Office of Consumer Affairs and Business ReguistIon 175982 08/26/2023 1000 Washington Street -Suite 710 Boston,MA 02118 AMERICAN INSTALLATIONS,LLC. WESLEY COUTURE /2 ' 130 COLLEGE STREET SURE too A:(04a4ef 4 i<04,-4 Not valid without signature SOUTH HADLEY,MA 01075 Undersecretaty 1 1 ACCPRE,0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/°D/YYYY) 08/30/2022 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 (A/C,No,Est): (NC,rlo): 8 North King Street E-MAIL bgrynkiewicz@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Employers Mutual Casualty Company II 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 9/4/23 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 W W 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 TEF4MS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POUCY EXP L MITS LTR INSD WVD (MMIDD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1 $ 1,000,000 X CLAIMS-MADE OCCUR PREMISESO(Ea occuE ence) $ 500,000 X Liquor Liability 10,000 MED EXP(Any one person) $ A 5D3535223 09/04/2022 09/04/2023 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JEl LOC PRODUCTS-COMP/OPAGta $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED 5Z3535223 09/04/2022 09/04/2023 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 UAB _ OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE 5J3535223 09/04/2022 09/04/2023 AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION X STUTE on- AND EMPLOYERS'UABIUTY Y f N TA 500,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA AMWC332951 09/04/2022 09/04/2023 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 fANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATIOIN. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD