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65 REDFORD DR BP-2017-0669 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-053 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2017-0669 Project# JS-2017-001092 Est.Cost:$2827.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor License: use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. ft.): 12501.72 Owner: DOYLE EDWARD F&SHIRLEY S Zoninv: Applicant: AMERICAN INSTALLATIONS LLC AT: 65 REDFORD DR Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:11/16/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:ATTIC & 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: FeeTvpe: Date Paid: Amount: Building 11/16/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File 4 BP•20I7-0669 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200 PROPERTY LOCATION 65 REDFORD DR MAP 36 PARCEL 053 001 ZONE THIS SECTION FOR OFFICIAL..USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OU Fee Paid . / Building Permit Filled out tVl'i Fee Paid Typeof Construction: ATTIC& SEMENT INSULATION&AIR SEALING TTHROUGHOUT 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 INFO ATION 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 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 De, olition Delay /r / Sign"e of Bur ding Official 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. 16-2021 . Depadmentuseordy Q \ City of Northampton status of Permit: �. Siding Department Curb Cuttodveway Permit 212 Main Street $ewerl5epBpava4abdi(y _ Room 100 WaterlWeil'Availebibty Northampton,MA 01060 TwoSets ofSluctuml Flares- phone 413567-1240 Fax 413-567-1272 PwvsRn Pins Otller$pacify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 property Address: This section to be completed by office 65 Redford Drive Florence, MA 01062 Map Lot Ura{. Zone Overlay District Elm St.District. CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Li Owner of Record: Shirley&Edward Doyle 65 Redford Drive Florence, MA 01062 Name(Pont) Cunent Mas Pddmss: (413)580095 Sec attached Telephone Signature 2.2 Authorized Agent American Installations 130 College St.,Ste 100 South Hadley, MA 01075 Name(Prat) Currant Milling Address: American Installations 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 $2,827.90 (a)Bulling Permit Fee 2. Elecbkdl (b)Estimated Total Cost of Construction tem(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection Jr 6. Total=(1+2+3+4+6) $2.827.90 Check Number d340 alJf a This Section For Official Use Only Building Permit Number: Date Issued: Signature: Bidding Comraissionertinspectra or Buildings Date Section 4. ZONING AU InformationMost Be Completed.Permit Can Be Denied Due To Incomplete information _®® Required by Zoning This column to board it by Building Myanmar 11� I Setbacks Front C C Side IC fel—i f r RLJ I [Ti] Rear rv--' laiallE11111 C":3 EWEN LailiaiallMINNIMI WE=S Open Space Footage ellineEll Open minus epond i —_ ,� FM: MelailiStel (volume 14Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 W YES,date issued:I I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW O YES O IF YES: enter Book C j Page I and/or Document#� B. Does the site contain a brook, body of water or wetlands? NO CJ DONT KNOW O YES O IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: i 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 C) NO C) W YES,describe size,type and location: I E. Will the construction activity disturb( ring,grading,excavation,or filling)over 1 acre or is it pad of a common plan that will disturb overt acre? YES NO O IF YES,then a Northampton Stem Water Management Pemaifrom the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House f'� Addition f3 Replacement Windows Alteration(s) fJ Roofing Or Doors O Accessory Bldg. ❑ Demolition ❑ Now Signs fat Decks IC) Siding gni Other l Brief Description of Proposed Work: Attu an basement insulation and air sealing throughout Alteration of misting bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Rofl -Sheet 6a. New house arid or addition to existing-housing,.compiete the following: a. Use of building:One Family Two Family Other b. Number of rooms In each family unit Number of Bathrooms 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 torn attached? h. Type of construction I. Is construction within 100 ft of wetlands? Yes T 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 T 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 Shirley d,Edward Doyle as Owner of the subject property hereby authorize American Installations to act on my behalf,in ail matters relative lovscit authorized by this building permit application. See attached 11111/16 Signature of Owner Date I, American Installations as OwnertAuthorized Agent hereby declare that the statements and Information on the foregoing application ere true and accurate,to the best of my knowledge and belkf. Signed under the pains and penalties of perjury. American Installations Pent Name American Installations 11/11/16 Signature of Comer/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Wesley K. Couture 106178 license Number 130 College St., Ste 100 South Hadley, MA 01075 9/29/17 Address Expiration Date g 631 AV-C.--4e3p552-0200 Signature Telephone 9.Registered Home Improvement Contractor. Not Applicable 0 Wesley Couture (A/p pe rat,J fr-e 175982 Company Name Registration Number American Installations VV 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.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 N No ❑ 11. r Home Owner Exemption The current exemption for"homeowners'was extended to include Owner-occupied Dwellings of one(I) 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 1083.5.1. Definition of Homeowner:Person(s)who own a parcel of land on wbieh he/she 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 constructs more than one home in a two-year period shall not he considered a homeowner. Such"homeowner^shall submit to the Building Official,on a form acceptable to the Building Official.that he/she shall be responsible for all such work performed under the buidine 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 reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the 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 ' - ' c n212 Rasin T OF BUILDING INal Sura roes 's` y -+✓, 23z Rain streetho• , Nit 3 0u3ldi*q s• .�pC Northampton, Nit 01060 � V0� Property Address: 65 Redford Drive Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley,MA Phone: 43-552-0200 Property Owner Shirley er Edward Doyle Name: Address: 65 Redford Drive City, State: Florence,MA 01062 7,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 Date 11/11/16 1.- �111 www Ameneanlnswlwtan..mm BBB. allata ocenStl&Insured �. MALYo.it 106378 American Installations MA AegrsMti0n R 17598$ lie College 5ttet5uile iW,South Madly.MA01025•Mac I41315524200 c e:1413i552U$D3•(mall:supponPAnwnreninstallanons.Lem Doyle,Shirley&Edward 11/4/2016 65 Redford Dr. n.n Florence MA 01062 413387,9532 Iw ere. `eq tlIPPS m lErna 442255 � 16-2021 Quantity Unit Unit Cost um Total Ale/Duct Seating AIR SEALING 8 man hour $ 85.00 $ 680.00 Air/Duct Sealing $ 680.00 Air/Duct Sealing Incentive $ (680.00) Air/Duct Selaing WI Balance $ - CRAWISPACE WALL RIO RIGID INSL sgit $ 318.20 HATCH SEAL&INSULATE each $ 60.00 $ 60.00 FIAT-i2"OPEN R-42 1 040 sgft $ 1.60 $ 1664.00 DAMMING R-38 MEI linear ft $ 2.05 $ 69.70 =letech $ 200 5 36.00 =I= ina ma_ Total Weatherization $ 2447.90 Weatherization Incentive $ 1,61093 Total Project $ 2,827.90 Total Utility Contribution $ 2,290.93 Total Customer Contribution $ $36.98 nauaannea can. C wad theab .mhtl bavw,xwhh a z ver wrtmmlap vnrtann AmerfUavium:.uetereb Ds ppaea m lumim,i nwaia am iabe to cmmrcte the above scope ptwork in...mordancy vis,the am,e.p CI..lao,and all local and a to wildi.g r gumionf m,the Total Conote value as stated heron. ACCEPTANU.OF PROPOSAOTbe above prices,spenM<bns and TOTAL CONTRACT VALUE= $ 536.98 condillOr15 art satisfactorY and are Hereby ac¢Nedr authomed to dowork a apeainm.Paymentwit he ars<kx,ron wlw to Down Payment= $ 178m ail 11-4-2016 start of wort,and Wkma due upon Conpkdm- pyo Balance Due Upon Completion= $ 35898 ,VoyDoyle,Shirley&Ed c('/jta7't'LT( w_...... 110/2016 Craig A.Dragovich ///��/m,/;/yl/C'9iv 11/4/2016 THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS UC HEREINAFTER REFERRED TO AS"COMPANY",AND THE CUSTOMER(S)NAMED ON THE REVERSE SIO,HEREINAFTER REFERRED TO AS"GWENT",ANO WILL BE SUBJECT TO ALL APPROPRIATE LAWS.REGULATIONS AND ORDINANCES OFTHE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,A5 WELL A5 ALL.LOCAL JURISDICTIONS. THE FO1LOWIN6 TERMS ANDCONDITIONS ALSOAPPLY 1,THIS AGREEMENT IS SUBJECT TO THE APPROVAL OFA MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION, 2,SHOULDOEFNILT BE MADE IN THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL BEAODEO FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(I-SITS)PERCENT PER MONTH, (18%PER ANNUM)WITH A MINIMUM CHARGE OF 51.00 PER MONTH,AND If PLACED IN THE 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 ONTHE PROPERTY. 3,THE COMPANY AGREES THAT WHEN DELAYS BECOME KNOWN TO THE COMPANY,THE COMPANY WILL ADVISE THE CLIENT Ai 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 DESCTBBEO IN A TIMELY AND WQRKMANUSE MANNER. 5.ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SUPPUED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE 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 S CHEQUIPMENT AND/OR PRODUCTS IN ORDER TO WIVATESUCH WARRANTIES. 6 THE QUOTATION DHOW PAGE HEREOF GOES 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. 7..1HECOMPANY'S LIABILITY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AGREEMENT PRICE EXCEPT'TO THE EXTENT THOSE DAMAGES ARE PROVEN TO RE SOLEY DUE TO THE COMPANY'S NEGUGENCE. B.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 WORT. 9.THE COMPANY IS NGF 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 THE PROBLEMI65 ON A TIME AND MATERIAL BASS.CLIENT AGREES THAT SUCH CONDITIONS ARE UNAVOIDABLE BY THE COMPANY AND SHALL IAT 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 HEIR THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES,INLCUDING BUT NETT LIMITED TO MOLD GROWTH,ARISING FROMTHEPERFORMANCE OF AIR SEALING WORK BY THE COMPANY AS A RESULT OF ANY KNOWN OR UNKNOWN MOISTURE CONDITIONS. It THE COMPANY IS NOT RESPONSWLE 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 BYTHE COMPANY. 12.REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,ROOF JACKS,VENTILATORS,FLASHING,RAFTERS,JOISTS,INSULATION OR OTHER MATERIALS ARE NOT INCLUDED UNLESS OTHERWISE NOTED HEREIN IV THE COMPANY WILL NOT BE RESPONSIBLE FOR THE SCRATCHING OR DENTING OF INTERIOR WALLS AND CEILINGS,FLOORS,TRIM,GUTTERS. DOWNSPOUT$.EXISTING SWING AND WINDOWS,DOORS,OIL DROPLETS IN DRIVEWAYS,HAIRLINE FRACTURES IN CONCRETE OR BLACYTOP DRIVES AND WALKS,OR DAMAGE TO PLANTS OR SHRUBBERY.IF EXCESSIVE DAMAGE IS CAUSED BY COMPANY COMPANY WILL REPAIROR REPLACEDAMAGED AREA ONLY AT COMPANY'SEXPENSE, 14.THE COMPANY UNDER PROVISIONS OF CHAPTER H[A OF THE GENERAL LAWS IS REQUIRED TO APPLY FOR AND OBTAIN ALI.CONSTRUCTIO-RE&AED PERMITS.THE COMPANY SHAM NOT RE DEEMED RESPONSIBLE FOR DELAYS IN THE WORK DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR INSPECTIONAL AGENCIES,AUTHORITIES,OR INDIVIDUA¢ IS,THIS AGREEMENT,INCLUDING THE PROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE CANNOT BE CHANGED OR ALTERED EXCEPT BYA WRITTENSTATEMENT SIGNED BY BOTH THE COMPANY AND THE CLIENT. 16,ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND DO NOT SURVIVETHE EXECUTIONOF THIS AGREEMENT. 17,THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN, 12.TISAGREEMENT.AND ANY WARRAMY(S)PROVW EO HEREUNDER SHAD,NOT BE ASSIGNED EXCEPT BY OR WITH THE WRIIIEN PERMISSION OFTHE COMPANY. W.6 THE CLIENT FALLS TO PERFORM TR OBLIGATIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT SNLL BE LIABLE FOR DAMAGES FOR T1EGREATER OF THECOMPANY'S ACTUAL DAMAGES OR 25%OP THE AGREEMENT FOR RESTOCKING FEE. 20.ANY CHANGES TO MATERIALS BY THE CLIENT WAND,STYLE,COLOR,EMI AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT IN A 5%R@STOCKING FEE BASED ON THE COST Of SAID MATERIALS. 21 THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL THE COMPANY RESERVES THE RIGHT TO REVOKE THIS PROPOSAL 50 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 SU DAY PERIOD;AFTER 9D DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE PROPOSAL COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE'N ACCORDANCE WITH ITS COSTS IN EFFECT AT SUCH TIME. 21.IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE THE VALIDITY AND ENFORCEBILDY OF THE REMAINING PROVISIONS OF THIS AGREEMENT SHALL NOV BE AFFECTED THEREBY, 30.ARBITRATION:IN THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS,CONDITIONS,PROVISIONS,OR PERFORMANCE OF THIS AGREEMENT.THE HARRIES 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 LI.E.MASS SAVER IS SUBJECT TO THE AVAILABILITY OF QUALIFYING STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTILITY PROGRAM IS DISCOUNONUED.FURTHERMORE,THE TERMS AND CONDITIONS OF STATE SPONSERED UTILITY PROGRAMSMAY BE ALTEREDOR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE. 25,AMERICAN INSTALLERS,LLC IS NOT AN AGENTOF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH OR UNDER THE MASSSAVEK ENERGY PROGRAM. 26 CLIENT IS REPSONSIBLE FOR THE PAYMENT OF ANY AND ALL FEDERAL STATE,OR LOCAL TAXESTHAT ARE APPLICABLE TO THIS AGREEMENT. The Commonwealth of Massachusetts Department of Industrial Accidents I*= kill—;{t Office of investigations �P N _ 600 Washington Street ip r Boston,MA 03fll 4' wronanaissgorldia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busmessrorgatliramt✓mdhdduuly American Installations,LLC Address: 130 College Street,Suite 100 City/State/Zip: South Hadley_MA 01075 Phone;L: 413-552-0200 iAre you an employer?Check the appropriate box: Type of project(required): ! 1.K I am a employer with 31 4. 0 I am a general contractor and I 6. 0 New construction ilisted on the attached shell.) employees(full and/or pan-time),` have hired the subcontractors 2.0 I am a sole proprietor as partner- 7. Remodeling ship and have No employees These sub-contractors havet 8. D Demolition wcapacity. comp. nsurance q working for me in any ca workers' insurance. El Building addition I ilio workers'comp.insurance 5. © We arca corporation and its I required.) officers have exercised their 10.-1 Electrical repairs or additions 3.0 t am a homeowner doing all work right of exemption per MOL 41.E Plumbing repairs or additions myself.(No workers'comp. c. 152,§1(4),and we have no : 12.0 Roof repairs i insurance requiredf t employees. [No workers' 13.M Other Insulation I comp.insurance required.) I —'— applicant that I:hoax box VI mutt aim lilt nun he se tion helms showing their market'compensation puling lnrnrmatinn_ ''Ilon¢ommr>who submit 0th aaieaei,indicating they aro ening all work and then him oussit aommcars must submit a m!m ef(do ft iodiatina sods_ krontmetors that oheck ntio bog mnvl anaehd an additional sheet shaving dm name of the sob-commotion.and(heir worker'comp.polity infntmarion. I am an employer that is providing workers'cornpmoador insurance far my employees. Below is the policy and job site is fonmrion. Insurance Company Name: Guard Insurance Companies Policy a;or Self-ins.Lie,�Pi: URWCy609917{� Expiration Date:: 00}9/04/2017 �i��y /'`'� /� Job Site Address: (05 Q ra sEi \ie.. City/staeer2ip: f Dr_exi&i iAN CAO(oa_ Attach a copy of the workers'compensation policy declaration page(shoving the policy number and expiration date} Failure to secure coverage as required under Section 25A of.MMGL 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 ofd STOP WORK ORDER and a line of up to S2S9.0O 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. (do hereby certify raider the pains and penalties of perjurthnt the information provided above it t fie and correct ,,Si'nria `/ :- t..4_. Date: _ Pthpnert0: 413-552-0200 I •Official use only. Do not write in this 0720,to be completed by city or town official. I ( City or Town: Permit/License# I Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector I i 6,Other LContact Person: _ Phones__,,,, A CERTIFICATE OF LIABILITY INSURANCE l�onwooi owl 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 CERTIRCATE HOLDER IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(ies)must 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 fights to the certificate holder In lieu of such endorsement(s). PRODUCER Linda Powers xHON ._.. Webber b Grinnell RaIM w Fag 1413)596-0111 I Nog 14331 nes-6981 9 North King Street nDNIe4s 1poweragwebberandgrinnell.coin INSUREMS)AFFORDING COVERAGE NAIL k_ Northampton 24A 01060 INSURER A Employers Mutual Casualty INSURED INSUREReberkshire Hathaway GUARD Ins. Co. American Installations, LLC INSURER C: Attn: Hee b Suzanne Couture INSURER01 130 College Street, Suite 100 INSURERS: South Hadley MA 01075 INSURER F: COVERAGES CERT9=ICATENUMBERMaster bop 9-2017 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. INSR TYPE OF INSURANCE �a� may" POLICYEXP DMS LIR msn WED POLICY HUMMER INM'D (M4UDp'YYYY1. I COMMERCIAL GENERAL LmeNnY EACH OCCURRENCE s 1,000,000 A X CLAIMS-MADE f OCCUR P AE TO RENTED osomtacr S 500,000 X Liquor Liability 503595217 9/4/2016 9/4/2017 MEDESp(A1,ore person) 5 10,000 PERSONAL 6AW INJURY 6 1,000,000 GENL AGGRE_GATEUMIIT APPLIES PER. GENERAL AGGREGATE S 2,000,000 X POVCYr IJP: 1 LOC PRODUCTS-COMP/OPAGG E 2,000,000 OOTHER. S AUTOMOBILE MINUTE COMPSINGLE LIMITLIMITE 1,000,000 IEagctidemldeml A ANY AUTO BODILY INJURY Par P4444) s ALLOWED fl SCHEDULED AUTOS 5Z353521i 5/4/2016 9/4/2017 HOOEY INJURY(Peraa4enQ 5 N-OWNED PRO AGE $ X HIRED AUTOS AUTOS (Pereetiampt_,,,, npp,Baac S 8,000 _X UMBRELLA LAS OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LAB — CIAIMS-MADE AGGREGATE $ 14000,000 DED X MEN-IX/NS 10,0W 553435217 9/4/2016 9/4/2017 " PER fiYH- s WORKERS COMPENSATION xI STATISM ER JAMIDTY AND EMPLOYERS'L " ANY PROPRIETOR/PARTNER/EXECUTIVEYIH MIA BE.L EACH ACCIDENT 5 500,000 OFFICER/MEMBER EXCLUDED? {Mancesey in HH) OAAC609917 W4/2016 9/4/2017 EL DISEASE-EA EMPLOYEE $ 500,000 HyeR d PTIONI Mw DESCRIPTION OFOPERATIpHS MImv E.L DISEASE-POLICY LIMIT5 500,000 A Commercial Property 513535217 9/4/2016 9/4/2017 deme1de91.00O $20,000 dedutueStrea $40,000 OESCRRTWN OF OPERA1*ONSI LOCABONS I gran ES(ACORD M1,Addmana Ramses Ne+M^en be mum/4S Peva mum a CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUMO W ZEO REPRESENTATIVE Kevin Joyce/LMP X-- 'Ti ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 mount, tMassachusetts-Department of Public Safety � Unrestricted-Buildings of any use group which / Board of Building Regulations and Standards contain less than 35,000 cubic feet(991m)of I Construction Supervisor ® enclosed space. License:IS-106176 - - t• vserrs o 166BNORIH 5�� '> South Hadley MROi - Failure to possess a current edition of the Massachusetts s 5",/..—/! 6fi.."luva v` Expiration State Building Code is muse for revocation of this license. I Commissioner 09/29/2017 cm ORS licensing information visit www.Mars$ov/oK Qc W 0/ • n0= Office of Consumer Affairs and Busi- ss Reg•-lation , 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Ckttrsstor Registration =7„.=.1,... Registration: 175982 "teEIr - Typo LLC -1!� i- = Expiration: 6/27/2017 TrIt 265208 AMERICAN INSTALLATIONS LLC.'.;./ - 1 WESLEY COUTURE 130 COLLEGE STREET SUITE 100-.;>, '---2F----;-=-=':= i' '' SOUTH HADLEY, MA 01075 ___ __-- Update Address and return card.Mark reason for change. MAI 0 20M-090 --' (] Address 0 Renewal 0 Employment (] Lost Card ur.onerrea!(/0/904madrne/d or6te of Consumer Affairs&Business Regulation License or registration valid for individual use only A "OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ?o -,Istratlon 115962 Type: Office of Consumer Affairs and Business Regulation • =lI' ' pimtlon:_c$kj2ptT_- LLC 10 Park Plaza-Suite 5170 e Boston,MA 02116 LL AMERICAN INSTAAYlONStat- , .7_, ifi C--.Y WESLEY COUTURE z i / 130 COLLEGE STREEYSI'IRE11f0 SOUTH HADLEY.MA 01075"' 'ndtr y _ lthout Undersecretary 1N valid without signature