24D-314 83 BANCROFT RD BP-2017-0280
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-Block:24D-314 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-0280
Project 4 JS-2017-000475
Est.Cost: 53438.86
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq. ft.): 20647.44 Owner: ALLEN FRANK
Zoning: URA(80)/URC(20)/ Applicant: AMERICAN INSTALLATIONS LLC
AT: 83 BANCROFT RD
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 Liability
SOUTH HADLEYMA01075 ISSUED ON:9/7/2016 0:00:00
TO PERFORM THE FOLLOWING WORK: ATTIC AND 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.
Certificate of Occupancy Signature: FeeType:
Date Paid: Amount:
Building 9/7/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
File P BP-2017-0280
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 83 BANCROFT RD
MAP 24D PARCEL 314 001 ZONE URA(SOVURC(20)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid _♦.
Building Permij.{'iI ed out t
; !
Fee Paid {� fit
Typeof Construction: ATTIC AND y
BASEMENT INSULATION AIR SEALING THROUGHOUT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 106178
3 sets of Plarss!Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INEiVtMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:$
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 Variances
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
• •• e v
•
P12:70"'
Signature of Iuildi g( fficial 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.
k0
I -1609
• 4✓ ti teh
44/ ", .F Depannientnae '
Q zd City of Northampton $te sotpennit
8 Building Department Sorb(wdoermit. Penmt
212 Main Street geweri anlbAvaftabuiry
Room 100 Waten\Val'Avatiab&,ty...l
Northampton, MA 01060 Tem SefporSaucmrel elan . -
phone 413-587-1240 Fax 413-587-1272 p$tt S,ptgtrc -
APPLICATION TO CORSTRUCt,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR IWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
5.1 P341e020ddress: This section to be completed by office
83 Bancroft Road Northampton, MA 01060 Map Lot tit,„
Zone Overlay District
Elm St.Dbaict. C13 District
SECTION 2-PROPERTY OWNERS HIPIAUTHORIZED AGENT
OWaerof Record:
Frank Allen 83 Bancroft Road Northampton,MA 01060
Name(Pita) Current
tMq?Addeo=
,See attached wogwre) 7473
Mamba
American Installations 130 College St., Ste 100 South Hadley, MA 01075
Herne(Mint) - Cumm Malting Addnum
American Installations 413-552-0200
alpMeee Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item anted Cost(Dollars)to be Official Use Only
completed by()emit applicant
1. Bth% $3,438.86 (a)BuSg Penna Fee
2. Electrical (b)Eenomied Total Cost of
Construstion from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Etre Protection
6. Total=(1 +2+3+4+5) $3,438.86 Check Number
This Section For ORbdd Use Only
SWding Permit Number �g
Datetl:
Signature:
Building CommisSionennWeclolof BelkIlhas Ode
Section 4. ZONING AU Infomation Mist Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Tit aobam to be aBN W by
Bolding Depumimt
Lot Size
Frontage
Setbacks Front
Side L:M1111 R L: I R:I I I I
Rear PI
Building Height I I I I
Bldg.Square Footage % I
Open Space Footage
uramInbL¼&pnd
Patina)
If of Parking Spaces f I I I I
Fill: j-- —1
(volume&Louden)
A. Has a Special PemdtNariance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES,date issued:I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES Q
IF YES: enter Book I Page and/or Document iL
B. Does the site contain a brook,body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES,has a permit been or tired to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 ,Date Issued:
C. Do any signs exist on the property? YES 0 NO Q
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 0
IF YES,describe size,type and location:
E. WD the construction activity disturb(dealing,gracing,excavation,railing)over 1 acre oris It pan of a common plan
that will disturb over 1 acre? YES Q NO 0
IF YES,then a Northampton Storm Water Management Pen dlt urn the DPW is required.
SECTION t-DESCRIPTION OF PROPOSED WORK(check all soolIWbt)
New House ❑ Addition 0 a Doors pema Windows Alla aUon(.) ❑ Roofing 0
Accessory Bldg. 0 Demolition ❑ New Signs Elj Dino ED Other OR
BM
work At�r�and us6 amen[ insulation and air sealing throughout
Alteration of Magna bedroom_Yes_No Adding rww bedroom Yes No
Matted Neuattw Renew:ding unfinished basemen _Yes No
Plans Attached Rol -Sheet
es If New house and or addition to existing.housing..comalelethe.following:
a. Use of building:One Family Two Ffly Ogler
b. Number of room In each tray wt Number el BNlaooms
L l there a garage attached?
d. Plop:aed Square'Dotage of new mratrudht Dfri.e sts's
e. Number Series?
I. Method of heating? Fkepaws or W e:Waiows Nater of each
g. Energy Coneencation Compliance. sbssdheck Energy Compliance kern attached?
h. Type cf construction
L t conflation Mein 100 A d maWhds?_Yea _No. Is construction within 100 yr, toodplab Yes No
L. Depth of Moment or Wier floor beim Wished grade
k. WBbalding condom to the BuldIng sd Zoning rogations[ Yes_No.
L Sepik Tams_ C#y Sewer_ Primate will Wiry rata Supply_
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Frank Allen as Omar of the subject
nervy
hereby suaa to American Installations
to act on my behalf,mel matters relative b wait autharbed by Use bulking perry application.
See attached 8/30/16
Stga.kn dormer Dur
I, American Installations as OeraUMIDherhed
Aged hereby declare that the sumacs and Wort-nation on the foregoing application are hue and accurate,to the hest of my knowledge
and NOM.
Signed under the yaks and penalties d bury.
American Installations
Print Nanw
American Installations 8/30/16
Signature of OarfAgay Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Nanw of Meuse wider Wesley K. Couture 106178
License Number
130 College St., Ste 100 South Hadley,MA 01075 9/29/17
Address Expiration Dae
413-552-0200
Sipnahae Telephone
. . .. . .. -.. ._ _. _ _.. . ..._ _ . . ..
9.ftedistered'Home ImprovementColltfactof L— ... : - : Not Applicable ❑
Wesley Couture /-i/ k. (o/jt%-c-- 175982
Company Name Raglstraton Number
American Installations 6/27/17
Address Expiration Date
130 College St., Ste 100 South Hadley,MA 01075 Telephone 413-552-0200
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e.152,f 25C16))
Workers Compensation Insurance affidavit must be completed and submitted with Es application.Failure to provide tita affidavit will result
in the della of the Issuance of the building permit
Signed Affidavit Attached Yes...._. it
11. -Home OvrnerExemption
The current exemption for"homeowners"was extended to include OwneroccupiedDwellso of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 10835.1.
Definition of Homeowner.Person(s)who own a parcel of land on which hdshe resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constricts more than one home In a twwvear period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,one form acceptable to the Building Official,that Waist shall be
responsible for all such work performed wader the Wilding permit,
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with u.G..ww to Chapin 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting inDeath)oft a Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
City of Northampton
Massachusetts #" 4
��yy33
H�{ ' i� }
L6P2 M*jt. S orin BOTIADINGWm1n SAirt"a[.LL068 s
212 a61n Stint a Municipal Etilettep Lw
}" a Nort0uptm, W 01060
Property Address: 83 Bancroft Road Northampton,MA 01060
Contractor
Name: American Installations
Address: 130 College Street Ste 100
City,State: South Hadley,MA
Phone: 43-552-0200
Property Owner
Name: Frank Allen
Address: 83 Bancroft Road
City,State: Northampton, MA 01060
I,American Installations (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,
IV K. CO'cretDate
8130116
I r ;;A, • wwwAmer$A$A$A,reaattc$A$
0
I BBB-
Hmrren:eat,o a m617:Inzu,na
a:
MA Reoistmtlon IX/75992
American Installations
130 Ceatp 3het Suite a00,Sa014 Halley,MA 0101$•at&t 1413)$52OW0 Fu:$413)552M202•fmaq:wppwnpNnvinnlm4Nlbns am
Allen,Frank 8/17/2016
p P mol
83 Bancroft Road Northampton MA 01060
ilatHikr 1E1,16271E1,1
6179477473
lAtenti438739 (p.m 16-1609
thlbdp
Incaim Quantity Unit Unit Cost Total
Sct Sea&e{
AIR SEALING 8 man hour $ 85.00 $ 680.00
Air/Duct Sealing $ 680.00
Air/Duct Sealing incentive $ (680.00)
Air/Duct Selaing WPC Balance $ -
Weatlwrbatioo
FLAT-14"OPEN R-49 984 sqft $ 1.69 $ 1,662.96
DAMMING R'38 188 linear ft $ 2.05 $ 38540
HATCH SEAL&INSULATE 1 each $. 60.00 $ 60.00
VENTILATION CHUTES 100 each $ 2.00 $ 200.00
CRAWLSPACE WALL RIO RIGID INSL 90 sqft $ 3.70 $ 333.00
INSULATED EXHAUST HOSE 1 each $ 50.00 $ 50.00
REMOVE INSULATION 90 soft $ 0.75 $ 5750
Total Weatherization $ 2,75886
Weatherization Incentive $ 2,000.00
Total Project $ 3,438.86
Total Utility Contribution $ 2,680.00
Total Customer Contribution $ 758.86
w mr, meM)nie to m.3 icrreit przemoethe abnw.nam temenee..ma 2 rear xxsmamsgwaaay
A
m Jkt nfor them,ul
6 nett*nonoses w mrjHn,a materiel ace lab Ib.emwere m.ab0t.¢..ne of Won in actolaapee»nn tate sEow SPtditalom and all Inca,nd,tate b,,Hing
Imn,eHaem.me.aH u,mr,a.aiw>:start*n.rem
ACCEPTANCE OF PROPOSAL.The above patens,weaecHlons and TOTAL CONTRACT VALUE $ 758.86
conditions are satisfactory and are hereby atc pt d You are yy
aulhaneed N do work as spttthed,Payment wlll he U3 down pew to Down Payment= $ 252-CO M
rtano&work,and balance due upon Completion. PAm
Balance Due Upon Completion= $ 506.86
•
8/17/2016
SitleM 144
8/17/'2016
me.
Ar..a.,tti .... n,..a i
THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY NE PARTIES INVOLVED.THIS AGREEMENT IS
BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS"COMPANY",AND THE CUSTOMERS NAMED ON THE REVERSE SIDE,HEREINAFTER REFERRED TO AS"CLIENT",AND
WILL BE SUBJECTTHO ALL APPROPRIATE LAWS.REGULATIONS AND ORDINANCES Of THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS.
THE FOLLOWING TERMS AND CONDITIONS ALSO APPLY
1 THIS AGREEMENT IS SUBJECT TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION.
2 ULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(1-1/2)PERCENT PER MONTH.
0.8%PER ANNUM)WITH A MINIMUM CHARGE OF 5300 PER MONTH,AND IF PLACED IN ME HANDS OF AN ATTORNEY OR COLLECTION AGENCY FOR COLLECTION,ALL ATTORNEYS'FEES,
EXPENSES AND COSTS Of COLLECTION SHALL BE PAID BY THE CLIENT.IN ADDITION,CLIENT UNDERSTANDS THAT IN FAILING TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY
HAVE THE RIGHT TO A LEIN ON THE PROPERTY
3.THE COMPANY AGREES THAT WHEN DELAYS BECOME KNOWN TONE COMPANY,THE COMPANY WILL ADVISE THE CUENT AS SOON AS REASONABLE.
4.COMPANY AGREES THAT,NOTWITHSTANDING ANY AGREEMENT FOR MATERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY IS RESPONSIBLE TO CLIENT FOR
COMPLETION OF ALL WORK DESCRIBED IN A TIMELY AND WORKMANLIKE MANNER.
5.ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SUPPJED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE NOSE GIVEN BY THE MANUFACTURERS OF SUCH EQUIPMENT AND
PRODUCTS.UNDER SUCH MANUFACTURER'S WARRANTIES,THE CLIENT MAY BE REQUIRED TO REGISTER OR MAIL IN A WARRANTY CARD OR OTHER EVIDENCE OF OWNERSHIP AND USE OF
SUCH EQUIPMENT AND/OR PRODUCTS IN ORDER TO ACTIVATE SUCH WARRANTIES.
6.THE QUOTATION ON THE PAGE HEREOF DOES NOT INCLUDE EXPENSES OR CHARGES FOR BOND OR INSURANCE PREMIUMS OR COSTS BEYOND NORMAL INSURANCE COVERAGE,ANY SUCH
ADDITIONAL EXPENSES,PREMIUMS OR COST SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT.
NE COMPANY'S LIABILITY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AGREEMENT PRICE EXCEPT TONE EXTENT NOSE DAMAGES ARE PROVEN TO BE
T SOLEV DUE TO THE COMPANY'S NEGLIGENCE.
DURING THE DURATION OF THE WORK,THE CLIENT'S HOMEOWNERS INSURANCE WILL BE RESPONSIBLE FOR ANY AND ALL DAMAGES AS LONG AS THE COMPANY HAS TAKEN THE
APPROPRIATE ACTION TO PROTECT AREAS OF WORK.
THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS.E G.WOOD ROT,
MOLD,ASBESTOS,NAIL POPS,DUCTWORK AND CONNECTIONS,PLUMBING AND VENT PIPES,DECKING DEFLECTION,ETC.IF A PREEXISTING DEFICIENCY OR HAZARDOUS MATERIAL IS
ENCOUNTERED PRIOR TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING,COMPANY WILL TRY TO ASSIST CLIENT WITHIN THE COMPANY'S MEANS AND CAPABILITIES
TO CORRECT NE PROBLEM(SI ON A TIME AND MATERIAL BASIS.CLIENT
AGREES THAT SUCH CONDITIONS ARE UNAVOIDABLE BY THE COMPANY AND SHALL NOT BE CONSIDERED A
VIOLATION OF THE AGREEMENT AND THAT DUE TO THESE CONDITIONS THE DURATION OF THE WORK AND SCHEDULED DATE OF COMPLETION MAY DIFFER FROM THAT AGREED UPON,IF
APPLICABLE UNDER THIS AGREEMENT.
10.THE COMPANY IS NOT RESPONSIBLE,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES,INLCUDING BUT NOT LIMITED TO MOLD
GROWTH,ARISING FROM THE PERFORMANCE OF AIR SEALING WORK BY THE COMPANY ASA RESULT OF ANY KNOWN OR UNKNOWN MOISTURE CONDITIONS.
11.THE COMPANY IS NOT RESPONSIBLE FOR,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES RELATING TO ICE DAMMING THAT MAY
ARISE DURING AND/OR AFTER THE PERFORMANCE OF WORK BY THE COMPANY.
12.REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,ROOF JACKS,VENTILATORS,FLASHING,RAFTERS JOISTS INSULATION OR OTHER MATERIALS ARE NOT INCLUDED UNLESS
OTHERWISENOTED HEREIN.
13.THE COMPANY WILL NOT BE RESPONSIBLE FOR THE SCRATCHING OR DENTING OF INTERIOR WALLS AND CEILINGS,FLOORS,TRIM,GUTTERS,DOWNSPOUTS EXISTING SIDING AND
WINDOWS,DOORS,OIL DROPLETS IN DRIVEWAYS,HAIRLINE FRACTURES IN CONCRETE OR BLACKTOP DRIVES AND WALKS,OR DAMAGE TO PLANTS OR SHRUBBERY.IF EXCESSIVE DAMAGE IS
CAUSED BY COMPANY,COMPANY WILL REPAIR OR REPLACE DAMAGED AREA ONLY AT COMPANY'S EXPENSE.
14.THE COMPANY UNDER PROVISIONS OF CHAPTER 142A OF THE GENERAL LAWS IS REQUIRED TO APPLY FOR AND OBTAIN ALL CONSTRUCTION-RELATED PERMITS.THE COMPANY SHALL NOT
BE DEEMED RESPONSIBLE FOR DELAYS IN ME WORK DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR INSPECTIONAL AGENCIES,AUTHORITIES,OR
INDIVIDUALS
15.THIS AGREEMENT,INCLUDING THE PROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE.CANNOT BE CHANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED BY BOTH THE
CLIENT.
16 ANY^REPRESFMATMS STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND DO
NOT SURVIVE THE EXECUTION OE THIS AGREEMENT.
17.THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTES EXCEPT AS OTHERWISE SET FORTH HEREIN.
12.THIS AGREEMENT,AND ANY WARRANTYISJ PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY OR WITH THE WRITTEN PERMISSION OF EHE COMPANY.
1A
IF THE CLIENT FAILS FPERFORM ITS OBLIGATIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT SHALL BE
LIABLE FOR DAMAGES FOR THE GREATER OF THE COMPANY'S ACTUAL DAMAGES OR 25%OF THE AGREEMENT FOR RESTOCKING FEE.
20.
ES TO MATERIALS BY NE CLIENT(BRAND,STYLE,COLOR,ETC.)AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TONE CLIENT COULD RESULT IN A 5%RE-STOCKING
FEE BASED ON THE COST OF SAID MATERIALS.
EFFECTIVE21 THIS AGREEMENT SHALL BE Y UPON ITS EXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL.THE COMPANY RESERVES THE RIGHT
TO REVOKE
AL 90 DAYS FROM DATE IT IS EXECUTED BY THE COMPANY IF IT IS NOT EARLIER EXECUTED BY THE CLIENT AND THE REQUIRED DOWN PAYMENT RECEIVED PRIOR TO
THE EXPIRATION OF SUCH 90 DAY PERIOD;AFTER 90 DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE PROPOSAL,COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE IN
ACCORDANCE WITH ITS COSTS IN EFFECT AT SUCH TME.
21.IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCEBILITY OF THE REMAINING PROVISIONS OF MIS AGREEMENT
SHALL NOT BE AFFECTED THEREBY.
23.
ARBITRATION.IN THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS,CONDITIONS,PROVISIONS,OR PERFORMANCE OF THIS AGREEMENT,THE PARTIES
AGREE TO PLACE THE MATTER INTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION ASSOCIATION TO RESOLVE THEIR DISPUTE.
24.ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM(I.E.MASS SAVE9 IS SUBJECT TO NE AVAILABILITY OF
QUALIFYING STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTILITY PROGRAM IS DISCOUNTINUED.FURTHERMORE,THE TERMS AND
CONDITIONS OF STATE SPONSERED UTILITY PROGRAMS MAY BE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE.
25.AMERICAN INSTALLERS,LLC IS NOT AN AGENT OF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE*ENERGY PROGRAM.
26.CLIENT IS REPSONSIBLE FOR ME PAYMENT OF ANY AND ALL FEDERAL,STATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AGREEMENT.
The Commonwealth of Massachusetts
_wg.— Department of Industrial Accidents
Eric=(1 Office of Investigations
s:• l=
_: '— I Congress Street,Suite 100
=.t E= Boston,MA 02114-2017
www massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organisation/Individual): American Installations, LLC
Address: 130 College Street,Suite 100
City/State/Zip: South Hadley, MA 01075 Phone It: 413-552-0200
Are you an employer? Check the appropriate box:
contractor and 1 Type of project(required):
L� 27 Iamaemployer with _ 4. ❑ I am a general
employees WI and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g. Q Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp.insurance) 9. ❑Building addition
required.] 5. 0 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 MOL 12.0 Roof repairs
insurance required.]t c. 152,§1(4),and we have no Insulation
employees. [No workers' 13.4 Other
comp.insurance required.]
*Any applicant that checks box NI 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 hive outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing thename of tbe sub-conmetorswed state whether or not those entities have
employees. If the subconaactors have employees,they must provide their workers'comp.policy Dumber.
. _. _. _.._.. ..._ ._.... _._ __. e
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
insurance Company Name: Guard Insurance Companies
Policy#or Self-ins. Lic. #: URWC600917 Expiration Date: 09/04/2016
' 3 Bancroft Rood blOrDxanrbnCMit Oi0(o0
Job Site Address: City/State/Zip:
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 MGI:.,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'nay 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.
/ (7 f
is to _'.�✓i.: ,.: ices.. !_' Date
Phone O: 9/.4-55a-OZoo
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 Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
A ae CERTIFICATE OF LIABILITY INSURANCE DATE
g/4 D";5'
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. TSS GERTWCATE 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 ADDMONAL INSURED,the policy(ies)must be endorsed. IV 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).
PRo0ticE '(ry4pMNYACT Linda Powers
Webber a Grinnell 4M,.1i.Fm. {443)556-0111is, ":u131sed-[dei
8 North Bing Street AAGOI S1powers@webberandgrinnell.cum
_ WMURERISI AFFORMNG COVERAGE NAILS
Northampton to 01060 INSURER A'al gyere Mutual Casualty
OmuREO BnuaER e3C0,14lJIBE GUARD
American Installations, LLC INSURERC:
Attn: Wes & Suzanne Couture SHERD:
130 College Street suite 100 INSURER E:
South Hadley NA 01075 INSURER 0:
COVERAGES CERTIFICATE NUMBERMaeter 9-2015 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. NO ARTIISTANDINO ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTI RESPECT TO VMICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TEE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
int TYPE OF INSURANCE 0100
PD QP
0100yMD PROVY NUMBER i @ POLICY messav YYYI- CMS
X COMMERCIAL GENERALWNIm EAMAGETO RENEE 1,000,000
A . X CUVMS-ACE EI OCCUR -O;44NAGETO ff`Niip mse I 50,000
AJIISEASEE/_- 503535216 9/4/2015 9/4/2016 MED EXP uisn//Jm/) 10,000
PERSONAL&ADE MIRY 1,000,000
GENL AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE 2,000,000
pEGT ( j)
a MEET JLOC PRODUCTS-CMPAWAGG 2,000,000
OTHER:
AUTOMDfLE 11AWLITY '10EOMSSNEED SINGLE OMIT 1,000,000
A ■ ANY AUTO NMILY INJURY IPA IMFFlI
II,RUFF EO R M:IIEGWELT 5E3535216 914/2015 9/4/Z016 ELT INJURY(Ma mcM&N)
X GISMO AUTOS X NON-0NNEO -WPOPERn twLIAC4V
UTOS WM
PIP-0aalc 8,000
X UMBRELLA UAB OCCUR EACH OCCURRENCE S 1y000,000
A ■ axons WB CLAIMS-MALE _AGGREGATE S 1 000 000
ii
DED X RETENTIONS 10,000 3J3535216 9/4/2015 9/t/2016
WORKERS COMPOlSArr4 . PER Oni
AND EMPLOTERWUNTICItt
STATUTE ER
ANY PALMI TdWMf yECUME YiR NI& EL.EACH ACCIDENT S 500,000
E I1Myaandatrym NH) 0mI0609917 9/4/2015 9/4/2016 EL DISEASE-EA EMPLOYEES 500,000
LESCRNmIQN OF OF OpERATENS tl4bN EL DISEASE-PUJCY LIMB S 500,000
A Commercial Property Sa3535216 914/2015 9!4/2016 &accm0100 20,000
Mama*SIPCO 60,000
DESCRIPTION OF OPERATIONS/LmiAl1ONS/VEHICLES ACORD 101,AddInnS Rswha Schedule,may 6a&Imbed N more apace M M1OMetlI
Proof of Coverage. Workers' Compensation policy includes class code 5474
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANON I FO BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELNERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPIUMEMATNE
Kevin Joyce/LMP C `•im---
kJ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025e7z1mro
fpMassachusetts-Department of Public Safety Unrestricted-Buildings of any use group which
Board of Building Regulations and Standards contain less than 35,000 cubic feet(99 tin )of
CLicens tlr S10 1711 uanOs2+'a space.
License:fS100178
sTis oF,
166 NORTH
CODTOjS it III
166 NORTH MAW S�f
South Hadley M. Ol
' Failure to possess a current edition of the Massachusetts
s'-' nix vs --State Building Code is cause for revocation of this license.
92--41 Expiration
Commissioner 0929/2017 For DPS licensing information nit www.Mass.Gov/nK
aLV V
Office of Consumer Affairs and Busr ss Reg lation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 175982
__ -. Type: LLC
Expiration 6/27/2017 Tilt 265208
AMERICAN INSTALLATIONS, LLC. .__.. :.
WESLEY COUTURE
130 COLLEGE STREET SUITE 100
SOUTH HADLEY, MA 01075
Update Address and return card.Mark reason for change.
SCA 20M out U Address 0 Renewal ❑ Employment U Lost Card
CTAe*,,,,,,,,,,„44 ojenif.acktati
Off fCoesum wN J &Budva Reg I Bon License or registration valid for mdwidul use only
W 1A1OME IMPROVEMENT CONTRACTOR before the expiration date If found return to:
isirahon: 175982 Type: Office of Consumer Affairs and Business Regulation
o.
Expiation. 6!172019 LLC ID Park Plaza-Suite 5170
- LIG
- Boston,MA 02116
AMERICAN INSTALLATIONS,lie
W0SLEY COUSTRE
AY/
/
130 COLLEGE STREET SUITE 100 ,, ,r>,-.,— f////(Y AT /7/.4"/
7/./i
SOUTH HADLEY MA 01075 Undersecretary N valid without signature