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25A-121 (6) BP+2022-1646 6 SHERMAN AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25A-121-001 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-2022-1646 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2022 Contractor: License: Est. Cost: 3505 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date: 09/29/2023 Use Group: Owner: R WILLARD TODD F&HEATHER Lot Size (sq.ft.) Zoning: URB Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC262555 SOUTH HADLEY, MA 01075 ISSUED ON: 12/27/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATION 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 VIO .ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: , 9 91 ATrP.IF • 5.2 - Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ;,,i,_ 1971 as -Pg76 �%";H M City of Northampton Del OR ;� ,.,-. ' Building Department jif ; ,t 21 Room Street INSULA TION ,,„,„,.., 1 Northampton, MA 01060 �-*:' phone 413-587-1240 Fax 413-587-1272 �".^rsF invio,4` ; i OIJL. ,,,,,v,, ,,,,,,,,,„ APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address: This section to be completed by officS 6 Sherman Ave Map Xii- Lot 12 L Unit Northampton MA Zone Overlay District 01060 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Todd &Heather Willard 6 Sherman Ave Name(Print) Current Mailing Address: 413-563-9933 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 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3505.54 (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 r`j��j 5. Fire Protection 6. Total=(1 +2+3+4+5) 3505.54 Check Number a-q y6 /�,/� This Section For Official Use Only Building Permit Number: 4/'-) 2 r 1(44,1 Issued:ate Is Signature: � �� /'2- 2.7. ZOZZ 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 frA 4- e—------- (413) 552-0200 z. 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 Address Expiration Date 1 7.4., 7'5 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 Sla No 0 Brief Description of Proposed Work NOTE: INS U LA TION ONL Y Attic and basement insulation and air sealing throughout. t, 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 12/9/22 Signature of Date Todd&Heather Willard , as Ownet 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 11/22/22 Signature of Owner Date City of Northampton 7 - '. Massachusetts ��? 3► '<< 211 DEPARTI.ZNT OF BUILDING INSPECTIONS �' 1j *r� � • 212 Main Street • Municipal Building Jy. Oa` Northampton, MA 01060 s.rbiY-3+''' 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: 3505.54 Address of Work; 6 Sherman Ave Date of Permit Application: 12/9/22 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: 12/9/22 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 My Massachusetts <. �:` * N; DEPARTMENT OF BUILDING INSPECTIONS ♦ 212 Main Street •Municipal Building t Northampton, MA 01060 ssbn .,%j.. 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: 6 Sherman Ave (Please print house number and street name) Is to be disposed of at: K 2'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: P p (Company Name and Address) 12/9/22 Signature Applicant or Owner Date �9 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. aYN City of Northampton 40 - • ems•'° Sic;. r' Massachusettsk * � DEPARTMENT OF BUILDING INSPECTIONS 9J, !` b 212 Main Street • Municipal Building Northampton, MA 01060 �bf+ MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 6 Sherman Ave Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner Name: Todd&Heather Willard Address: 6 Sherman Ave City, State: Northampton MA 01060 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 Aze....."1-A Date 12/9/22 American Installations Oh. Home Performance Contractor 130 College Street,South Hadley,MA 01075 American Installations CONTRACT - WZ 413-552-0200 FAX 413-552-0202 Page 1 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENTS WORK ORDER Todd Willard (413) 584-7035 09/09/2022 446646 86705 ERVICE STREET - - - - - - - - - - ---BILLING STREET PR6POSED BY: 6 Sherman Avenue 6 Sherman Avenue American Installations SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 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 10 $943.30 $943.30 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 1 $31.81 $31.81 Provide labor and materials to install Q-Ion weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 3 $78.33 $78.33 Provide labor and materials to install a doorsweep to restrict air leakage. ATTIC DAMMING-R-38 FIBERGLASS 32 $77.44 $58.08 $19.36 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 144 $253.44 $190.043 $63.36 Provide labor and materials to install a 9"layer of R-33 Class Cellulose added to open attic space. SLOPE-R19 FIBERGLASS 784 $1,505.28 $1,128.96 $376.32 Provide labor and materials to install a 6"layer of R-19 fiberglass batts to a sloped ceiling area. ATTIC HATCH-INSULATE ONLY 1 $35.00 $26.25 $8.75 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. COMMON WALL-2" RIGID BOARD 84 $364.56 $273.42 $91.14 Provide labor and materials to install rigid board at R-10 or greater to a common wall area. All seams will be sealed with tape. American Installations Home Performance Contractor 130 College Street,South Hadley,MA 01075 CONTRACT - YYZ American Installations 413-552-0200 FAX 413-552-0202 Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# WORK ORDER Todd Willard (413) 584-7035 09/09/2022 446646 86705 SERVICE STREET BILLING STREET PROPOSED BY. 6 Sherman Avenue 6 Sherman Avenue American Installations SERVICE CITY.STATE,ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL VENTILATION CHUTES 62 $216.38 $162.29 $54.09 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. Total: $3,505.54 Program Incentive: $2,892.52 Customer Total: $613.02 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Six Hundred Thirteen &02/100 Dollars $613.02 COMPANY REPRESENTATIVE CUST•• Rcar,:ck NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DITE ,� DAYS. ` _ The Commonwealth of Massachusetts Department of Industrial Accidents --;.' = / Office of Investigations C : .. air Lafayette City Center 2Avenue de Lafa yette,1 ► ar a ette, 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. ['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. n 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 10.❑ Electrical repairs or additions 3.E I am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ 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. #:AMWC332951 Expiration Date:09/04/2023 Job Site Address: 6 Sherman Ave City/State/Zip: Northampton MA 01060 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 Signature: 9, Date: 12/9/22 Phone#: 413-552-0 00 Official use only. Do not write in this urea,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3OCity/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0 Other Contact Person: Phone#: • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Staricktniiip Cortats, v4 LIS tsar CS-106178 tres: 08/29/2023 -144. WESLEY cotrru 139 PACKA I PELHAM MA ke- ;tit Ce toner ',Kt" Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home improvement Contractor Registration Type: LLC Registration: 175982 AMERICAnNES'STALLAji2r,LLE ic?o. Expiration: 06/26/2023 130 HADLEY,MA 01075 Update Address and Return Card. Moe of Consumer Affairs a Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:LLC before the expiration date. If found return to: Ilactitatetim Exaltation Office of Consumer Athdrs and Business Regulation 175982 06/28/2023 1000 Washington Street -Suite 710 , AMERICAN INSTAULATIONS,LLC Boston MA 02118 WESLEY COUTURE a 711/ 130 COLLEGE STREET'surrE EY s Not valid without signature SOUTH HADL , o°MA 01075 Undersecretary AC® CERTIFICATE OF LIABILITY INSURANCE DATE(MMI00/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 Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 LAIC,No,Ext): (A/C,No): 8 North King Street E•M/ILADDRESS: bgrynkiewiCz@webberandgr nnell,com INSURER(S)AFFORDING COVERAGE NAIC# 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 9/4/23 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. NOTVNTHSTANDING 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) LIMNS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 X CLAIMS-MADE OCCUR PREMISES(Ea occurrence) 1 $ X Liquor Liability 10,000 MED EXP(Any one person) $ A 5D3535223 09/04/2022 09/04/2023 PERSONAL 8,ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 /POLICY X Mr- 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 5Z3535223 09/04/2022 09/04/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY x:AUTOS ONLY (Per accident) $ PIP-Basic $ 8,000 X UMBRELLALIAB - OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS UAB CLAIMS-MADE 5J3535223 09/04/2022 09/04/2023 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,- 000 $ WORKERS COMPENSATION X PEATUTE ERH AND EMPLOYERS'LIABILITY Y I N 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 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