25C-126 (5) 16 ELIZABETH ST BP-2017-0836
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C- 126 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-2017-0836
Project# JS-2017-001400
Est. Cost:$2514.00
Fee: 50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq. ft.): 5183.64 Owner: BACHAND PAUL
Zoning: URB(100)/ Applicant: AMERICAN INSTALLATIONS LLC
AT: 16 ELIZABETH ST
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:1/6/2017 0:00:00
TO PERFORM THE FOLLOWING WORK AT IC & 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 1/6/2017 0:00:00 se6 (16
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File 1 BP-2017-0836
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 16 ELIZABETH ST
MAP 25C PARCEL 126 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM Ell,,LED Oidf
Fee Paid
Building Permit Filled out
Fee Paid
TyU4of Constructign_ATT &IgA ENT INSULATION&AIR SEALING THROUGHOUT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
BuildingPlans Included:
Owner/S . e tent or Lin.e 106178
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQ&MATION PRESENTED:
ApprovedAdditional 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 Storni Water Management
D iti.• relay
-d-t7
Signature of Buil.' g Off gal Da e
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 MOL 40A.Contact Office of
Planning&Development for more information.
16-2192-A
•
Department meanly
ti(KS\ `City of Northampton Status of Permit
_Building Department CurorCtNaiyeway PemN
212 Main Street SeweylSepticaYallati y
Room 100 WeterMed`Avaleb9ity
i' Northampton, MA 01060 Two Sets otstntcttlrei Plana
/ phone 413-567-1240 Fax 413-587-1272 PIoU$Ite Plans
�/ olh@r Speetry ._
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
16 Elizabeth Street Front Map Lot unit
Northampton,MA 01060 zone Overlay District
Elm St.Disbicl, - CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Paul Bachand 16 Elizabeth Street Front Northampton, MA 01060
Name(Print) Current Midi?Address:
(413)325-
See attached Telephone
3395
Signature
2.2 Authorized Mont:
American Installations 130 College St., Ste 100 South Hadley, MA 01075
Name(NM) - Cermet MaAng Address:
American Installations 413-552-0200
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COST%
Item Estimated Cost(Dollars)to be Official Use Only
completed by permk applicant
1. Building $2,514.30 (a)Budding Permit Fee
2. Eiecbdtat (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.rue Protection ,/
6. Total=(1+2+3+4+5) $2,514.30 Check NumbercYs �7 066-
This Section For Official Use Only
Date
Building Permit Humber. issued:
Signature;
Building Commissioner/Inspector of Buildings 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
Builtng Depvtomt
Lot Size I
Frontage I
Setbacks Front I
Side L:I i It- I L:I I R: I
Rear
Building Height
Bldg.Square Footage
Open Space Footage _ V.
(Lot area minus bldg&paved I I I
Panting)
#of Parking Spaces �
Fill:
(volume&Lacau®)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:)
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book I I Page I and/or Document Al
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0
IF YES, has a permit been or need 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 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 0
IF YES,describe size,type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre oris it part of a common plan
that will disturb over l acre? YES 0 140 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 ❑ Addition ❑ Replacement Windows Atteration(s) 0 Rooting 0
Or Doors 0
Accessory Bldg. ❑ Demolition 0 New Signs lfl1 Decks [CI Siding[f7) Other iit
Brief Description ofproposed
Work Attic and basement insulation and air sealing throughout
Alteration of existing bedroomYes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ga.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 Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimansfmns
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mass-check Energy Cwrpganceform attached?
h. Type of construction
i, Is constriction within 1DO ft.of wetlands? Yes �._No. Is construction within 100 yr. floodplain Yes No
I. 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_.
SEC11ON 7a•OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Paul Bachand as Owner ofthe subiect
Property
hereby authorize American Installations
to act on my behalf,in all matters relative to work authorized by this building permitapp icagon.
See attached 1/3/17
Signature of Owner Date
I, American Installations as OwnertAuthorixed
Agent hereby declare that the statements and information on theforegoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
American Installations
Print Name
American Installations 1/3/17
Signature of OwnertAge t Date
SECTION 8-CONSTRUCTION SERVICES
0.1 Licensed Construction Supervisor. Not Applicable ❑
Na fu gain- Wesley K. Couture 106178
License Number
130 College St.,Ste 100 South Hadley,MA 01075 9/29/17
Address / _,L_ Eyikattai Dare
‘nature
� ( (J7./.b&C 413-552-0200
gnature Telephone
9.Registered Home ImpraXemeMConVector. _ _... _... Not Applicable ❑
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.152,9 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 buffeting permit.
Signed Affidavit Attached Yes—.. B) No ❑
11. -Home Owner Exemption
The current exemption forhomeowners"was extended to include Owner-occuo led Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for him who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 10833.1.
Petlaition 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 struttores accessory to such use and/or farm
structures.A oerdon who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shalt submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all sack work performed under the bnlidiauermit,
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 gable for person(s)
you bite to perform work for you under this permit
The undersigned"homeowner"certifies and assumes responsibility far 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 Ae2s crc;
DEPARTMENT OF BUILDING INSPECTIONS 2.. I
>E 212 Main street a Municipal Building i`�M1 OC6
=_ Northampton, Na. 01060 -V. W C
Property Address: 16 Elizabeth Street Front
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property OwnerPaul Bachand
Name:
Address: 16 Elizabeth Street Front
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.
Contra forign ure
LA//At1C l i-rzt rc�
Date
1/3/17
`l f BBB. 1 www.Amentanlnetanannnanm
Conn!r
Licensed&106178
MA Q1 o:105182
American Installations MARegistration pvs4R7
130 ConneStreet Suite 100,South Hadley,MA 01075•Office: 4131552.0200 Fax:141315524202•Email:support@AmnbnlnsORanans.com
Bachand,Paul 12/15/2016
16 Elizabeth Street(front) Northampton MA 01060
413 325 3395 prbachand4664@aol.com
442661 iM ��
16-2192 A
Quantity Unit Unit Cost Total
Air/Duct Sealing
MR SEALING 2 man hour $ 85.00 $ 170.00
DUGSEALING 4 man hour $ 80.00 $ 320.00
WEATHERSTRIP DOOR&ADD SWEEP 5 each $ 80.00 $ 400.00
Air/Duct Sealing $ 890.00
Air/Duct Sealing Incentive $ (890.00)
Air/Duct Selaing W%Balance $ -
1WeatherizaUon
CRAWLSPACE WALL RIO RIGID BOARD 30 each $ 4.05 $ 121.50
ATTIC FLAT-4"FLOORED R-14 CELLULOSE 1,064 soft $ 1.24 $ 1,319.36
ATTIC DOOR-INSULATE&WS 1 each $ 110.00 $ 110.00
ATTIC FLAT-10"FLOORED R-34 CELLULOSE 48 soft $ 1.53 $ 73.44
Total Weatherization $ 1,624.30
Weatherization Incentive $ 1,461 87
Total Project $ 2,514.30
Total Utility Contribution $ 2,351.81
Total Customer Contribution $ 162.43
WARRANTY.Ames,„n iketauarwm,ac will provide the above stated homeowner with a year workmanship warrant'?
American Installations,riC hereby proposes atd hereall atem
nal and labor to complete the above scope of work in accordance with the above speclfiotnns and all local and state buildingreyula6onsbrtM1eipol contract Nluearmrtd herein.
ACCEPTANCE OF PROPOSAL:The above prices,specifications and TOTAL CONTRACT VALUE= $ 162.43
conditions are satisfactory and are hereby accepted.You are
authorized to do work as specified.Plull be 1/3 down prior to Down Payment= $ 54.00 tp
start of work,and balance due upon Completion. PA I6
Balance Due Upon Completion= $ 108.43
0/514A12/15/2016
°"),""'"-P"'", mil p.• 12/15/2016
THIS AGREEMENT IS comresob es THIS PAPP
AP PIA OFTIPS PAPE AND SHAY OE COPISIOPIADTHE AIME APPIEEMEHI BP AIE PIMPS PIVOLVED TIPS AGIREEMETN5 BETWEEN AMERICAN IPSTAPATIONS. PEPPIPPFTER
REFRREDro S mMPANr.AND THE MADMAN MED ABOVE.HEREIN/MP LAWS.asnwriws AND 0Ru NeNos Of THE STAT[CP.va<,C.matr:re
THIS AGREEMENT IS COMPOSED OFTHIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT I$
BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TORS"COMPANY",AND THE CUSTOMER(S)NAMED ON THE REVERSE SIDE,HEREINAFTER REFERRED TO AS"CLIENT",AND
WILL BE SUBJECT TOALL APPROPRIATE LAWS REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCALIURISDICTIONS.
THE FOLLOWING TERMS AND CONDITIONS ALSO APPLY
1.THIS AGREEMENT 15SUBJECT TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION.
2.SHOULD 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(1-1/11 PERCENT PER MONTH.
(18%.PER ANNUM)WITH A M NIMUM CHARGE OF 5200 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 RIGHTTOA LEIN ON THE PROPERTY.
3.THE COMPANY AGREES THAT WHEN DELAYS BECOME KNOWN TO THE COMPANY,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 DESCRIBEO IN ATIMELY 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
PROOUCTS.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
ADDIPONALE%PENSES,PREMIUMS OR COST SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT.
J.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 RE
SOLEY DUE TO THE COMPANY'S NEGLIGENCE.
B. DURING THE DURATION OF THE WORK,THE CLIENTS 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.
9.THE COMPANY IS NOT RESPONSIBLE FOR PREIXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PRIXESS.E.G.WOOD ROT,
MOLD,ASBESTOS,NAIL POPS,DUCTWORK AND CONNECTIONS,PLUMBING AND VENT PIPES,DECKING DEFLECTION,ETC.IF A PRE-EXISTING DEFICIENCY OR HAZARDOUS MATERIAL IS
ENCOUNTERED PRIOR TO OR DURING CONSTRUCTION,AND COMPANY 15 NOTIFIED IN WRITING,COMPANY WILL TRY TO ASSIST CLIENT WITHIN THE COMPANY'S MEANS AND CAPABILITIES
TO CORRECT THE PROBLEM(S)ON A TIME AND MATERIAL BASIS.CLIENT AGREES THAT SUCH CONDITIONS ARE UNAVOIDABLE BY THE COMPANY AND SHALL NOT BE CONSIDERED A
VIOLATON OF THE AGREEMENT AND THAT DUE TO THESE CONDITIONS THE DURATION OF THE WORK AND SCHEDULED DATE OF COMPLETION MAY DIFFER FROM NAT 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 ANU/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 WRING 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 OTTER MATERIALS ARE NDT INCLUDED UNLESS
OTHERWISE NOTED 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 141A 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.
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
COMPANY AND THE CLIENT.
16.ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREEDD-O BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND DO
NOT SURVIVE THE EXECUTION Of THIS AGREEMENT.
U.THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN.
18.THIS AGREEMENT,AND ANY WARRANTY(S)PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY OR WITH THE WRITTEN PERMISSION OF THE COMPANY.
19.IF THE CLIENT FAILS TO PERFORM ITS OBLIGATIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT SHALL BE
UABLE FOR DAMAGES FOR THE GREATER OF THE COMPANY'SACNAL DAMAGES OR 25%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 ROUTE TO THE CLIENT COULD RESULT IN A 3%RE-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 90 DAYS FROM DATE IT IS EXECUTED BY THE COMPANY IF IT IS NOT EARLIER EXECUTED BY THE CLIENT AND THE REQUIRED DCW N 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 ODE.
22.IF
ANY S OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCEBILITY OF THE REMAINING PROVISIONS OF THIS AGREEMENT
SHALL NOT BEAFFECTED THEREBY.
23.ARBITRATION:INTHE 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 NT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM(I.E.MASS SAVE)IS SUBJECT TO THE AVAILABILITY OF
QUALIFYING STATE SPONSORED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTILITY PROGRAM IS DISCDUNTINUED.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,DR UNDER THE MASS SAVE'ENERGY PROGRAM.
26.CLIENT IS REPSONSIBLE FOR 114E PAYMENT OF ANY AND ALL FEDERAL,STATE,OR LOCAL TAXES THAT ARE APPLICABLE TOTHIS AGREEMENT.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Ihrg Office of Investigations
,;' 600 Washington Street
myI_l ' Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name dsesinesyOrganitatioivtndividual)__American Installations,LLC
College Street,Suite
Address: 130 100
City/State/Zip- South Hadley, MA 01075 Phone#: 413.552-0200
Are you an employer?Check the appropriate bo,: Type of project(required):
1.N t am a employer with 31 4- ❑ I am a general contractor and I 6. fl New construction
employees(full and/or part-time).* have hired the sub-contactors Remodeling
L.[ I am a sole proprietor or partner- fisted on the attached sheet t
ship and have no employees These sub-contractors have 8. []Demolition
working for me in any capacity. workers'comp, insurance. 9. 0 Building addition
[No workers'comp.insurance 5. El We are a corporation and its
required.{ officers have exercised their I0.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL lin Plumbing repairs or additions
myself[No workers'compc. 152,§1(4),and we have no 12.0 Roof repairs
insurance required.)' employees. No workers'
13.1A Other Insulation
comp. insurance required_] _4
'Any applivreni that cheeks bon HI mutt also lilt out the section below showing their workers'compensation policy information
'I knmcowncrs who submit this affidavit mdinating they an doing an work and then hire outside umtr ctors mast submit a new affidavit iodating sucha
to tractors that dick this box mum attached an additional sheet thawing the name or the sanconrmetors and their workers'comp.policy information.
I am 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 tl or Self ins. Liu.It AMWC731485 Expiration Date: 09/04/2017
Joh Site Address: (0 Ei 'Lobel\ SFrcek ¶ t0( * City/State/Zip: . ( 111 00 ii . n
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiation date).
Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties ofa
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of S FOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information providedabove is true and correct.
Signature; sj .�/I • f. ist a _ Date: I01{3-
Ebone k: 41:3-55.:0200
Official use only. Do not write in this area,to be comphaed by city or town official
City or Town: Permit/License/4
Issuing Authority(circle one):
I.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
ACtE d CERTIFICATE OF LIABILITY INSURANCE DAm"YYeD0OF4n
fir.---" 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 polcypes)must be endorsed. N SUBROGATION IS WANED,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).
PROOUCER SACT SailldH Powers
Webber S GrILZ¢11 Pix M. (413)586-011.1 olo7At -taa3J sa6-Nal
8 North King Street EEWt E1 @webberan Smell,corn _
ADDRESS: FnwSrS Agri
WSUREWSJ WORDING COVERAGE NAC•
NorthaNpton HA 01060 WSUREaA EmplOVere lmtual Casualty
SHORED NrsURcxsserkshire Hathaway WARD Ina. Co
American Installations, LLC INSURER C:
Attn: W®8 & Suzanne Couture INSURER O:
130 College Street, Suite 100 INSURERE:
South Barney MA 01015
9-201:
COVERAGES CIES Of INSURANCE
exp 9-201 ED REVISION NUMBER:.
THIS INDICATED.IS TO GNOIEY THAT THE PANIRE UI INSURANTE M OR O NDYu NAVE BEEN ISSUED CORE INSURED CUMEN ABOVE FER ECT POLICY PH THII
CERflICNMAYaBE ISSUEDSUEIANY Y PERTAIN,
THE
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH ECT RESPECT TO CH THIS
EXCLUSIONS BOR MAY THE ISS HOWN AFFORDEDHAVBY THE POLICIESDPIDCLAIMS.DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C
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TYPE OF INSURANCE D , 4 paLILYEnXUMB - n1WeGNYW1 IMMJCSIYYYNI -... OMITS LL
COMMERCIALOENEPP.L Wexm Px71OC_URRiNCE : 1,000,000
t—, _
A Xi CUxn5nADE .- .00CUR M E CE n -44 ; 500,000
X • Li or Liability 503535217 9/4/2016 9/4/2017 mED EXP(Anyma Person) 10,000
PERSONAL&ADS INJURY 1,000,000
I GEN'L AGGREGATE LIMIT APPLIES PER I GENERAL A& REOAT£ 2,000,000
IX PCX.CY'77.78i `LCC PRODUCTS•CMPAP NOG 2,000,000
. !OTHER'
AUTOMOBILE LIAaLITY COMBINFDSIN@LE LIMIT 1,000,000
(E cc9149
A 'ANY AUTO BODILY INJURY Per poison)
211.plASED r!AUTO6ULED 529539217 9/422016 9/4/2017 SONNY INJURY(Pm mvlwe
.AUTOS
R SIRED AUTOS X MiFWVHEO ROFERTi MYAFi`c
_ _.4JT05
! IPIP-BIP-BeNc 8,000
IBX UMBRELLA LIAR IOCCUR EACH OCCURRENCE 1000,000
A MASS Use I CLAIMS-MADE I AGGREGATE 1,000,000
0E0 l X I RETENTIONS 10,000 533529217 9/4/2016 914/2019
WORKERSCOMPPNSAMW 'PER !OTH-
ASOEMPLOYERS'LMn
SRY YIN TAPJt£ ..,
ANY PRCY+RIETOSPARTNER,£%ELCTIVE TFR
!OFFICER/MEMBER EXCLUDED? MIA SEL FACNACCIOEM IE 500,000
B (Mandat4y In NIO URNS-009917 9/4/2016 ' 9/4/2011 EL.DISEASE-FA IMPLOYEBi 500,000
u yes.de c,,,Oe under
DE56HIGTON OF OPERA NON&helve I E DISEASE.POLICY LIMIT 15 500,000
•
A Commercial Propsrty 351521' 9/44 2016 9/a/1019 soSo $20.000
•aedumee step $40,000
DESCRIPTION OP OPERATIONS I LOCATIONS I VEHICLES 14190R1)101,Adnional Remarks Stnodu e,may be 4'0CMd Nmmrt space Sr squired)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESEmARW£ �.yJ
Kevin Joyce/LEP T'T
(d 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
/NS025n914nn
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(991m3)of
CL : Supzrvisnr enclosed space. ,
License CStst''78
0
WESLEY COUTL4JhE ie nom r' -
166 NORTH MAIN s
South Hadley MA'Oi �1 s,
(\ Failure to possess a current edition of the Massachusetts
sa - State Building Code is cause for revocation of this license.
92,/! , 'uExpiration
Commissioner 09/29/2017 for BPS liwsing information cit wrw.Mass.Gov/DPS
L./its VO 4'1 I #J L (/' %i iazioadeledeeJ�L�iS
qUOffice of Consumer Affairs and Busi ss Reg'-lat+on
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 175982
Type: LW
__. Expiration: 6/27/2017 flit 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 I r, zou--osis E Address ❑ Renewal E Employment Et Lost Card
i- Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
W !i(Irm IO ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
p �streho0' 175982 Type: Office of Consumer Affairs and Business Regulation
;:Expin[lon:_ 621/201? LLC 10 Park Plaza-Suite 5170
Boston,MA 02116
AMERICAN INSTALLATIONS,LLC
WESLEY COUTURE
130 COLLEGE STREET SUITE 100
SOUTH HADLEY MA 01075 Undersecretary N valid without signature