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17A-256 .._ ........... ..� www.Americanlnstallations.com � r s Licensed&Insured MA CSL#:106178 LL MA Registration#175982 American Installations 341 Newton Street,South Hadley,MA 01075 Office:(413)552-0200 Fax:(413)552-0202• Email:support@Americanlnstallations.com Andrews,Christine&Steven 11/11/2014 IL,G ",t) (Date) 115 Oak Street Florence MA 01062 IAddres:l Icnvl (state) Izipl (413)977-3162 cmgandrews @gmail.com (Name) ICelll (Email) 406939 14-1074 Nob in ISite ID) Quantity Unit Unit Cost Total Air Sealing AIR SEALING 6 Iman hour 1 $ 75.00 $ 450.00 DOOR WEATHERSTRIPPING W/SWEEP 1 leach 1 $ 75.00 $ 75.00 Total Air Sealing $ 525.00 Total Air Sealing Incentive $ 525.00 Weatherization FLAT-7"OPEN R-25 520 sgft $ 1.24 $ 644.80 DAMMING R-38 22 linear ft $ 2.05 $ 45.10 HATCH SEAL&INSULATE 1 each $ 60.00 $ 60.00 CRAWLSPACE WALL R10 RIGID INSL 80 sgft $ 3.52 $ 281.60 Total Incentivized Weatherization $ 1,031.50 Total Project $ 1,556.50 Total Utility Contribution $ 1,298.63 Total Customer Contribution $ 257.88 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 2 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= $ 257.88 conditions are satisfactory and are hereby accepted.You are authorized to do work as specified.Payment will be 1/3 down prior to Down Payment= $ 85.00 � 11/11/14 PAID start of work,and balance due upon Completion. Balance Due Upon Completion= $ 172.88 / II�I1 4 -- Date Signa— Andrews,Christine &Steven Property Owner(Sign) Date Property OwnerlPrin[) Craig A. Dragovich RepreseMa[ive(Print) Represema (Sign) 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 TOM"COMPANY",AND THE CUSTOMER(S)NAMED ABOVE,HEREINAFTER REFERRED TOM"CLIENT',AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL MALL LOCAL JURISDICTIONS. swam The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 1! Pr 1 t^4 �n��T�A�t Cll 1 1 d LL A' Address: 3qj /Vew�gn (StReret__ City/State/Zip:S%j�, 2 A 6)615 Phone#: y 0- 55a- OaOO Are on an employer. Check the appropriate box: Type of project(required): 1 I am an employer with 1.1_ 4.01 am a general contractor and I 6.❑New construction employees(full and/or part time).* have hired the sub-contractors 7.[1 Remodeling 2.®I am a sole proprietor or partner- listed on the attached sheet. 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.OWe are a corporation and its 10.❑Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGL insurance required]t c. 152,§ 1(4),and we have no 12.❑Roof repairs employees.[no workers' 13. Other tQ�t�o comp.insurance required.] u *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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. 11 1 Insurance Company Name: �(�{�T C� Q jQ a PO[�I� r(, ecS �1'1S I c-,a jjG2, alomk)an t! Policy#or Self-ins.Lic.#: 1 O Expiration Date: qT=�— ���Z_ Job Site Address: CU L City/State/Zip. 2 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 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Print Name cl t 212A Q_ Phone#: �i3 f�'SoZ O`LOD Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Issuing Authority(circle one): 1.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#• SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [ Sidin ] .Other[ Brief Work: 'o of( p s d ye( el-)-�- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing, complete the following: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrcoms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT. 1 ✓t t� `t�-� 1 K a � 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. 'P2 � �C Q cal C- Signature of Owner Date American installations I, ,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. American Installation Print Name Arr erican Installations 1 4 ��s ! Signature of Owner/Age Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ____. ...- __-_ Frontage _..__ _ Setbacks Front - - "-- Side LL _ R __..__ L'__ R: Rear Building Height - Bldg.Square Footage -- % Open Space Footage -__-_-. % (Lot area minus bldg&paved _[ parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW © YES IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW Q YES O IF YES: enter Book Page; I and/or Document#� B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 3 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit NOV 2 ' 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability EI Ctr c f r pO ciions Northampton, MA 01060 Two Sets of Structural Plans p one 413-587-1240 Fax 413-587-1272 PlottSite Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office ry—�-� Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Chr Andreu- s 1 �5 OaK 5 Y Azt �Namee((Print) ,/ 1 Curyevrlt IYI iWgg�1c e�^ a I(o2- �ze— .l m Ut Telephone l•'�' I Signature 2.2 Authorized Agent: American Installations zn r„tl ae St e Name(P o#—) urrerit AI'ipg Address: South Had ey, M Vl U J -0200 Signatur Telephone SECTION 3-tSTIMATFD CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ` 1 U o (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) o — Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0594 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 341 NEWTON ST SOUTH HADLEY (413)552-0200 PROPERTY LOCATION 115 OAK ST MAP 17A PARCEL 256 001 ZONE URB(100) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INSTALL ATTIC INSULATION&AIR SEAL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 106178 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR ATION PRESENTED: pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition D y Si kh at of Ti Zi 6g Wi cial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 115 OAK ST BP-2015-0594 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-256 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catego!y: INSULATION BUILDING PERMIT Permit# BP-2015-0594 Project# JS-2015-001126 Est. Cost: $1100.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. ft.): 10802.88 Owner: ANDREWS STEVEN&CHRISTINE Zoning: URB(100) Applicant. AMERICAN INSTALLATIONS LLC AT. 115 OAK ST Applicant Address: Phone: Insurance: 341 NEWTON ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:11/21/2014 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL ATTIC INSULATION & AIR SEAL 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/21/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner