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17A-122 (2) 60 CLAIRE AVE BP-2017-0831 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 122 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-2017-0831 Project# JS-2017-001389 Est.Cost: $2345.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: • Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(su.ft): 31276.08 Owner: PAWLOSKI JAMES W&JEAN K Zoning: RI(too)/URA(100)/ Applicant: AMERICAN INSTALLATIONS LLC AT: 60 CLAIRE AVE Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:1/5/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:ATTIC & BASEMENT INSULATION AND 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 1/5/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Fite a BP-2017-0831 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200 PROPERTY LOCATION 60 CLAIRE AVE MAP 17A PARCEL, 122 001 ZONE RI(109)/URA(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 Type Construction: ATTIC& BASEMENT INSULATION AND AIR SEALING THROUGHOUT New Construction Non Structural interior renovations Addition to Existing Y* n. Accessory Structure Buildin¢,Plans Included: Owner/Statement or License 106178 3 sets of Plans I Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: //4pproved ... 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 She 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 Signature of Buildi'g •'tet al 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. 16-2312 Department USe ordy C of Northampton Status of Remit httki ng Department tbirb CutlDiwevmy Pam* ' Tv. sers of sou' \. Northampton,3 2 2 Maus Street Sewdrl6epacAva@a` --'Room 100 WateriWell Availability pt MA 01060 d41 Plarrs - t ' phone 413-587-1240 Fax 413-587-1272 Ptwrsne Pians ' Other$pedry- 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 60 Claire Avenue Map Lot Unit. Florence,MA 0I062 Zane Overlay Distrtet Elm St District CB District SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Jean e'r James Pawloski 60 Claire Avenue Florence, MA 01062 Name(Pdnl) Current Melling Address: (413)584 7007 See attached - Telephone Signature 2.2 Authorized Agent American Installations 130 College St., Ste 100 South Hadley,MA 01075 Name(Peng Current Mamma 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 $2,345.20 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Consbud!ontom(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fre Protection /,/^ 6. Total=(1 +2+3+4+5) $2,345.20 Check Number - G s+0/; This Section For Official Use Only Budding Permit Number Date Dated Signature: Brddalg Commissiariedinspector of Bullrings Dal Section 4. ZONING AB Information Must Be Completed.Permit Can Be Denied Due To Incomplete Infohratlpa ' Existing Proposed Required byZoning This column lobo filled in by Building Department Lot Size I I Frontage I L__. Setbacks Front I 1 Side L:1 It LI I R: I 1 Rear (—I I I Building HeightI II I III Bldg.Square Footage I % 1 1I Open Space Footage % Clot area minus bldg&paved I L I I I I�I Parking) #of Parking Spaces r—I i _j I I Fill: F----------1 (volume&Landon) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW 0 YES O IF YES,date issued:I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES O IF YES: enter Book I Page and/or Document#i_ I B. Does the site contain a brook, body of water or wetlands? NO 0 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: C. Do any signs exist on the property? YES O 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 O NO O IF YES, describe size,type and location: E. Will the construction activity disturb(clearing,grading,excavation,ortilbng)over I acre or Is it part of a common plan that will disturb over I acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. • SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House r] Addition ❑ Replacement Windows Alteratlon(s) ❑ Roofing 0 Or Doors 0 Accessory Bldg. 0 DemolItion D New Signs [Cj Decks (p Siding(a] Other(lt Bdef Description of reposed Wartc Attic and basement insulation and air sealing throughout Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Nanative Renovating unfinished basement Yes No Plans Attached Rog -Sheet Sa.If New hoose ander addition to existing housing,complete the.followlnq: 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 Canptianoe form attached?- h. Type of construction I. Is construction within 100 ft of wetlands? Yes No. Is consWctlon within 100 yr. floodplain Yes No j. Depth of basement or actor floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City SewerT Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Jean 6-James Pawloski asOwner of the subject pmperty hereby authorize American Installations to act on ray behalf,In a&matters mb.tive to work authorized by this building permit application. See attached 1/3/17 Signature of Owner Date I, American Installations as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and acuate,to the best of my kmrwledge and belief. Signed under the pains and penalties of perjury. American Installations Print Name American Installations 1/3/17 Slants of OwneriAgen Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable Cl Name of License Holder Wesley K. Couture 106178 License Number 130 College St., Ste 100 South Hadley, MA 01075 9/29/17 Address Expirebon Date Signature14,4( ��/ / 1e 552-0200 (J phone 9.Redisiered-Home improvement Contractor: - Not Applicable 0 Wesley Couture 175982 Company Name Registration 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 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..._.. B( No 0 11. r Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings 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 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 be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official.that hefshe shall be responsible for all such work performed under the building pern t. 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 pe®it 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 /i• Massachusetts t. F `4c S� DEPARTMENT OF BUILDING INSPECTIONS i 212 Main Strait a Municipal Building `_..:-. Northampton, MA 01060 8/1� Property Address: 60 Claire Avenue Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley, MA Phone: 43-552-0200 Property Owner d James Pawloski Name: Address: 60 Claire Avenue City, State: Florence, MA 01062 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. Contractorsi nature 12.E of Date 1/3/17 S / l Amer nln:ullatins • B7-131 licensed&Insured L• MA 6(X:106178 American Installations MA Registration#175982 L30 College Street Suite 100-South Hadley,MA 01075•Office:(4131552-0210 He(413)552-0202•Email:support@Amerkenlnstallatlom.com Pawloski,Jean&James 12/19/2016 arai (kW 60 Claire Aye. Florence MA 01062 i.eml 413.584.7007 pawloskq@comcast.net p.m w 444947 (01) WW116-2312 WNIDI m Quantity Unit Unit Cost Total Air/Duct Sealing AIR SEALING 10 man hour $ 8500 $ 85000 WEATHERSTRIP DOOR&ADD SWEEP 2 each $ 80.00 $ 160.00 Air/Duct Sealing $ 1,01000 Air/Duct Sealing Incentive $ (1,010.00) Air/DUCE Selaing WX Balance $ - Weatherizatlon ATTIC HATCH-SEAL&INSULATE 1 each $ 60.00 $ 60. 0 ATTIC FLAT-5"OPEN R-19 CELLULOSE 960 soft $ 1.26 $ 1,209.60 ATTIC DAMMING-R-38 FIBERGLASS 32 sok $ 205 $ 65.60 Total Weatherization $ 1,335.20 Weatherization Incentive $ 1,001.40 Total Project $ 2,345.20 Total Utility Contribution $ 2,011.40 Total Customer Contribution $ 333.80 WARRANTY American numeono uC Stated wu w. the.awe e homeowner with a l year woman wanamy. .eanlamnatmmoont LCCmrehntractwwoposesmeasna mmAh all material alabe to comrkplete the above scope of won m accordance with the above specifications and alor lnnd nae building ACCEPTANCE OF PROPOSAL The above prices,specifications and TOTAL CONTRACT VALUE_ $ 333.80 conditionssatisfactoryereby aceptd.You authorized to do work as pecned.Payment will be 1/3 down prior to Down Payment= $ 111.00 C5 12-19-2016 start of work,and balance due upon Conn pletian. PA ID Balance Due Upon Completion= $ 222.80 Pawloski,Jean&lames m. 12/19/2016 (00000(00) Craig A.Dragovich / minT '12-19-2016Her w-enw.law m. THIS AGREEMENT 15 COMPOSED OFT1115 PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMET IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS"COMPANY",AND THE CUSTOMERISI NAMED ON THE REVERSE SIDE,HEREINAFTER REFERRED TO AS"CLIENT',AND WILL BE SUBJECT TO ALL APPROPRIATE TAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL A5 All LOCALJURISDICTIONS. THE FOLLOWING TERMS AND CONCt1ONS ALSO APPLY 1.THIS AGREEMENT IS SUBJECT TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECIVE UNDER ANY CONDITION. 2 SHOULD DEFAULT BE MADE IN TILE PAYMENT OFTHIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(11/2I PERCENT PER MONTH. (18%PER ANNUM)WITH A MINIMUM CHARGE OF$1,00 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 HAVETHERUNE MA LEN ON PEE BROPER_TC 3.THE COMPANY AGREES THAT WHEN DELAYS BECOME KNOWNTO THE(AMPANY,THE COMPANY WILL ADVISE THE CLIENT 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 SUPPLIED 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 INA WARRANTY CARD OF OTHER EVIDENCE OF OWNERSHIP AND USE OF SUCH EQUIPMENT AND/OR PRODUCTS IN ORDER TO ACTIVATE 5001 WARRANTIES. 6.THE°NOTATION ON THE PAGE.HEREOF DOES NOT INCLUDE EXPENSES OR CHARGES FOR BOND OR INSURANCE PREMIUMS OR COSTS BEYONDNORMAL INSURANCE COVERAGE,ANY SUCH ADDITIONAL EXPENSES,PREMIUMS OR COST SHALLBE ADDED TO THE TOTAL AGREEMENT AMOUNT, 7.THE COMPANY'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 BE SOLER DUE TO THE COMPANY'S NEGLIGENCE. S.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 AREASOE WORN. 9 THE COMPANY IS NOT RESPONSIBLE FOR PREEXIS19NC DEFICENOES OR HAZARDOUS MATERIALS THAT MAMFEST THEMSELVES DURING THE CONSTRUCTION PROCESS_E-G.WOW ROT, MOLD,ASBESTOS,NAIL POPS,DUCTWORK AND CONNECTIONS,PLUMBING AND VENT PIPES,DECXING DEFLECTION,ETC.IF A PRE-EXISONG DEFICIENCY OR HAZARDOUS MATERIAL IS ENCOUNTERED PRIOR TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING,COMPANY WINTRY TO ASSIST CLIENT WITHIN THE COMPANY'S MEANS AND CAPABILITIES TO CORRECT THE PROBLEMIS)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 TC THESE CONDITIONS THE DURATION OF THE WORK AND SCHEDULED DATE OF COMPLETION MAY DIFFER PROM THAT AGREED UPON,IF APPLICABLE,UNDER THIS AGREEMENT, IO,TLE COMPANY R NOT RESPONSIBLE AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS,FOR AW PROBLEMS AND/OR DAMAGES,INLNgNi BUT NOT LIMITED TO MOLD GROWTH,ARISING FROMTHE PERFORMANCE OF AIM SEALING WORK BY THE COMPANY AS A RESULT OF ANY KNOWN OR UNKNOWN MOISTURE CONDITIONS. 11.THE COMPANY IS NOT RESPONSIBLE FOR,AND THE CLIENT AGREES TO MOLD THE COMPANY HARMLESS,FOR ANY PROBLEMS AND/OR DAMAGES RELATING TO ICE DAMMING THAT MAY ARISE DURING AND/OR AFTER THE PERFORMANCE CF WORK BY THE COMPANY. 11.REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,ROOF JACKS,VENTILATORS,FLASHING,RAFTERS.JOISTS INSULATION OR OTHER MATERIALS ARE NOT INCLUDED UNLESS OTHERWISE NOTED HEREIN. H.THE COMPANY WILL NOT SE 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 WALK,OR DAMAGE TO PLANES 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 1424 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 THE WORK DESCRIBED IN'THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR INSPECTIONAL AGENCIES,AUTHORITIES,OR INDIVIDUALS IS,THIS AGREEMENT,INCLUDING THE PROVISIONS RELATING TO PRICE AND PAYMENTSCHEDULE'.,CANNOT BE CHANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED RV RUTH THE COMPANY AND THE CLIENT. lb.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 EXECUTION DF THIS AGREEMENT. 17.THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN. SE.THIS AGREEMENT,AND ANY WARRANTOR)PROVIDED HEREUNDER SHALE NOTRE ASSIGNED EXCEPT BY ORW!TN THE WRITTEN PERMISSION OF THE COMPANY, H.IF THE CLIENT FAILS TO PERFORM ITS OBLIGATIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,NE CLIENT SHALL BF LIABLE FOR DAMAGES FOR THE GREATER OFTHE COMPANY'S ARUM DAMAGES OR I5%OF THE AGREEMENT FOR RESTOCKING FEE. 20.ANY CHANGES TO MATERIALS BY THE CLIENT(BRAND.STYLE,COLOR,ETC.]AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTETO THE CLIENT COULD RESULT IN A 5%RESTOCKING 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 RESERVE'S THE RIGHT TOREVOKE THIS PROPOSAL BD DAYS FROM DATE IT iS EXECUTED BY THE COMPANY IF IT IS NUTEARLIER EXECUTED BY THE CUENT AND'THE REQUIRED DOWN PAYMENT RECEIVED PRIOR TO THE EXPIRATION'S SUCH'#i DAT PERIOD,AFTER S0 DAYS,AND IN THE EVENT COMPANY MfS NOT REVOKE THE PROPOSAL COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE IN ACCORDANCEWITH ITS COSTS IN EFFECTAT SiCSTIME. 12.IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORfABLE THE VALIDITY AND ENFORCEBILRY OF THE REMAINING PROVISIONS OF THIS AGREEMENT SHALL NOT BE AFFECTED THEREBY. 23 ARBITRATION:IN THE EVEMTHE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS,CONDITIONS,PROVISIONS OR PERFORMANCE OF THIS AGREEMENT,THE PARTIES AGREE TO PLACE THE MEMENTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION ASSOCIATION TO RESOLVE THEIR DISPUTE. 24.ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR O11.1ER PROGRAM THAT R PART OF A STATE SPONSERED UTWTY PROGRAM DE.MASS SAVE')155URIECTTO THE AVAIL AVARATENEY Q QUALIFYING STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSEREO UTILITY PROGRAM IS DISCWNDNUED.FURTHERMORE THE'TERMS AND CONDITIONS OF STATE SPONSERED UTILITY PROGRAMS MAY BE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE. 15.AMERICAN INSTALLERS.LLC IS NOT AN AGENT OP ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVES ENERGY PROGRAM. W CLIENT IS REPSONSIBLE FOR THE PAYMENT OF ANY AND ALS FEDERAL STATE,OR LOCAL TARESTHAT ARE APPLICABLE TO THIS AGREEMENT. The Comnsonwealth of Massachusetts I. ,.-,_= Department of Industrial Accidents =t Office of Investigations !. —7 � 600 Washington Street d=lily c. Boston,MA 02111 z>a wwn'.ntass,gov/dia Workers' Compensation Insurance Affidavit Builders/Contractorsfklectricians/Plumbers Applicant Information Please Print Legihly Name (BavnessiOrgmtludonnndividuap: American Installations,LLC Address: 130 College Street„Suite 100 City/Slate/Zip: South Hadley,MA 01075 Phone ii: 413-552-0200 Are you an employer?Cheek the appropriate bun: Type of project(required): t.riti 1 am a employer with i 31 4. [) I am a general contractor and I 6. ❑ New construction employees Hull anon part-tine).' have hired the. subcontractors 1 2.IL I am a sole proprietor or partner- listed on the attached sheet, : 7 Remodeling ship and have no employees These subcontractors have 8. U Demolition working for me in any capacity. workers' comp. insurance. 9. �...� Building addition INo workers comp.insurance 5. ❑ We art a corporation and its required.] officers have exercised their IqJ—� Elec6ical repairs or additions 3.0 I am o homeowner doing all work right of exemption per MGI. ILL j Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no ii 12,1J Roof repairs insurance restaged.'t employees.[No workers' comp insurance required.] ( 13.TA OthY Insulation 'Any applicant that cheeksbeal must also ell thearoorwnd theirworkers'a policy lbaon. 'Ilamuwnnrwho s is this affidavit cid a they aredoing allwork and lave hire ousulb-contcdust submit new affidavit indicating. :Gmlmtlzrha check this box must attached on additional sheet rvhnwlu0the name unite sub-contractors aid their workers'comp.Outs ifomalien. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy audit*site information. Insurance Company Name: Guard Insurance Companies Policy ,Policy 0 or Self-ins. lie &((. AMWC731485j�� *' Pao._ pepnatron Daley 09/04/2017 ',AA ^^�� Job Site Address:_..,toe C,'l al fe. P Ciry/State/Zp:_et&ttece ',AA 0tL�te e_„ 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 Mit,c, 152 can lead to the imposition of criminal penalties ofa line up to$1,500.00 audios one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S2:000 a day anaiisi the violator_ Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /de hereby certify nailer the pains and penalties ofperjn y that the information provided above is true and correct. 5i mat:r- e_ r/Ir . i - Date: _._Li3' 1 Phone Pi 413-55 -0200 Y Official use only. Do not write in this area,to be completed by city or lawn official City or Town: Permit/License 4 Issuing Authority(circle one): I. Board of Health 2. Building Department 3.Citvfrmvn Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other I Contact Person: I Phone#: ACO va CERTIFICATE OF LIABILITY INSURANCE DATE INWOcu 9/1/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Linda Manors Webber & Grinnell lArp11c bx fm. (413)586-0111. 12N, Mtn 5W-6481 _. 8 North Xing Street "MILss:!powers@webberandgrinnell.COM INSUREMS)AFFORDING COVERAGE NAM It Northampton MA 01060 INSURER Emplayera Mutual Casualty, NFSUREn anuRERS$orkahrre Hathaway GIIA1t° l.ne. Co. Aneriean Installations, LLC INSURER C: Attn: Wes & Suzanne Couture INSURER 0: 130 College Straetr Suite 100 INSURER E! South Hadley a1A 01015 mBURERF_ COVERAGES CERTIFICATE NUMBER Laster £%p 9-2017 REVISION NUMBER: THIS IS TO CERTIFY THAT. THE POLICIES OF INSURANCE LIS!EO BELOW WAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POI..ICY 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 POI'CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSSRR ,.. ABbL NOW I POLICY Ere POLICY IX _ P I - - • IMPEDE INSURANCE INBO YAM PODGY NUMBER I IMMOWYTY)I IMMmorroYI I LIMITS COMMERCIALGENERAL LIAWLT" 1 - EACH OCCURRENCE 5 1,000,000 A I'' 1 X j CLAIMS-MADE/ONBNADE OCCUR PR G 0 Fg4nOMnce) •5 500,000 `X Lasuor Liability 503535211 19/4/2016 9/4/2017 MED Exp y ww(Wwn) I$ 10,000 PERSONALS ADVINJURY $ 1,000,000 GEN-1 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3.000,000 X_Wt;CY_PEQ LO _ C f PRODUCTS.COMCXWAGG S 2,$00,000 S OMdenS AUTRRI E LINEALLY IICOMS�INFo SINGLE LIMIT F 1,000,000 A --'ANY AUTOBO0 (Pieper-son) S ALL OWNEDK SCHEDULED 5£3535217 9/4/2016 9/4/2017 1 BODILY INJURY(Pet a.aee,1 AUTOX HIRED<LTOE X NON-OVMEO :..A EKY DAMAGE S AUTOS .4 ?L S. PIP-Basic :E 8,000 X UMBRELLA LIAR .1---IS OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS SIAe ICLAWS-MADE: 1 AGGREGATE IS 1 000,000 0E0 11 X RETENTION 10,000 1 543533217 9/4/201.6 9/4/2017 IS woRNEEgCOMPENSA11411 : % PERRE .ETH ANO PRDPRYERSIDLOR AIDLM Y f N` ANY MEMER EXCLUDED' Et EACHACCIDENT S 500,000 B mandatory innNER E%CW DFD? iNlr`I ORMC609917 9/4/2016 9/4/2017 IIt es.SeC RN) E DISEASE LEMPLOVEE5 $00,000 s E'er DESCRIPTION OF OPERATIONS below E L DISEASE—POLICY LIMIT I$ 500 000 A Covmmrc,al Property 5w3535211 9/4/2016 19/4/2011 uemehem SL 000 $20,000 i ,um2Les:coo $40,000 DESCRIPTION 0P OPE511ON5 rLOCAT W S f VEHICLES IACORD 101,Additional Remits SAIRd IC.may be auchs N more spate M method) 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. MEMORIZED REPRESENTAuVE j i )i:e'✓ir. Joyce/LNP "" 4—_. _ EO 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered(narks of ACORD 1N3025 I?n,LPL IFMassachusetts -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 Cons:ruUi n Supers co =OM enclosed space. License: fS-106178 Tl WESLEY COUTO*IE - v4'4. - 166 NORTH MArot South Badley IRA;01 /J V Failure to possess a current edition of the Massachusetts r Expiration State Building Code is cause for revocation of this license. jam.�l 'w Commissioner 09/29/2017 far OPS liceamgmformationnsit www.Mass.Gov/OP5 ,,OftC6,71) ) / 3_ rff 192PQ .P.C7i> G 0./ i i (y Office of Consumer Affairs and Busi ss Reg'.-lation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 175982 Type: LLC Expiration: 627/2017 Tr# 265208 AMERICAN INSTALLATIONS, LLC WESLEY COUTURE 130 COLLEGE STREET SUITE 100 - SOUTH HADLEY, MA 01075 Update Address and return card.Mark reason for change. scar a 20M 05/11 - Address n Renewal E Employment Q Lost Card rrl4e Vcimmowemild Office fConsumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: e9istrauon: 175962 Type: Office of Consumer Affairs and Business Regulation Expiration: 6/27/2017, LLC 10 Park Plaza Suite 5170 Boston,MA 02116 AMERICAN INSTALLATIONS,LLC WESLEY COUTURE �j� ,/ 130 COLLEGE STREET SUITE 100 //^/(,/ SOUTH HADLEY,MA 01075 Undersecretary N alid without signature