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239 BROOKSIDE CIR BP-2017-1127 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36- 109 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-2017-1127 Project# JS-2017-001913 Est. Cost:$4716.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sq. ft.): 24306.48 Owner: SAVINO SCOTT A&JILL M SNIADACH Zoning: Applicant: AMERICAN INSTALLATIONS LLC AT: 239 BROOKSIDE CIR Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:4/10/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:ATTIC AND 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 4/102017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1127 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200 PROPERTY LOCATION 239 BROOKSIDE CIR MAP 36 PARCEL 109 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT ,1( Fee Paid ? / Building Permit Filled out 'Unb Fee Paid Typeof Construction: ATTIC AND BASEMEN INSULATION AND AIR SEALING THROUGHOUT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Pians Included: Owner/Statement or License 106178 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN OR ATION PRESENTED: pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received Be Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management em. - o• ki- ;. �0,L: ' Y- 17-0693 / '.UepaflmeM use'oiiFj City of Northampton Status of PermR Building Department Curb cWlNdvey;ay P-ertNt ( , - 212 Main Street Sewer1Beplkavaxab3ity PQM ' - rte Room 100 WaterMell Availability Northampton,MA 01080 taro$ets oTSWchAaiFMaru_ phone 413-587-1240 Fax 413-587-1272 FNoNsxa Plans _ - - - ° Other spedfy APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 PrullertvAdfdres{: This section to be comp!!p y office 239 Brookeside Circle Map 30 tot jV 1Mat. Florence,MA 01062 Zone Overlay District Elm SL District— CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZEO AGENT 2.1 Owner of Record: lune Savino&Jill Sniadach 239 Brookeside Circle Florence, MA 01062 Name(Print) Current Mafing Address: (413)586-0536 See attached Telephone Signature 2.2 Authorized Agent, American Installations 130 College St., Ste 100 South Hadley, MA 01075 Name(Print) (parent Mang Address: American Installations 413-552-0200 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimate Cost Wars)to be Oxfdall Use Only completed by permit applicant 1. Buxdbng $4,716.22 (Madding Permit Fee 2. Electrical (b)Estimated Total Cost of Conshucxm from(S) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection � � 6. Total=(1+2+3+ j 4+5) $4,716.22 Check Number 4410 1.1'�-r This Section For Official Use Only Building Permit Number Date Issued Signature: Building CommIssionerAnspecdor 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 Building Department Lot Size I L Frontage _JI Setbacks Front Side Li I it Li • I & I 7-1 Rear r i I Building Height i En Bldg.Square Footage I I I %e I I Open Space Footage (Lot ma minus bMg&paved L I I parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special PermitNariance/Finding ever been issued for/on the site? NO Q DONT KNOW Q YES Q IF YES,date issued. IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book Page and/or Document#L B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q 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 Q HO Q IF YES, describe size, type and location: I E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is It part of a common plan that will disturb over 1 acre? YES Q NO Q 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 Alterations) ❑ Roofing 0 Or Doors CI Accessory Bldg. ❑ Demolition ❑ Now Signs EMI Decks (p Siding 9l) Other[IA Brief Description ofppmposed Woric Attic and basement insulation and air sealing throughout Alteration of existing bedroom YesNo Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes �No Plans Attached Rog -Sheet Se.If New hpitse and or addition to existing ticiuslnN..cotrlpiete 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? I. Method of heating? Fireplaces or Woodstoves Number of each_„_, g. Energy Conservation Compliance. Masschecc Energy Compliance form attached? h. Type of construction consbucbon within 100 a.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or velar too below finished grade k. Will building conform to the Building and Zoning regulations? Yes_ No. I. Septic Tank City Sewer Private wellCity water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT June SavinoP+r Jill Sniadach as Owner of the subject property hereby authothe American Installations to act on my behalf,in al matters relative to work authorized by this building Parma application. See attached 413/17 Signature of Owner rote I, American Installations as Owner/Authorized Agent hereby declare that the statements and information on the foregoing appNaatian are but and accurate,tote best of my knov4edge end belief. Signed under the pains and penalties of pejwy. American Installations PEPName American Installations 4/3/17 Signature of QmertAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Hower: Wesley K. Couture 106178 License Number 130 College St., Ste 100 South Hadley, MA 01075 9/29/17 A/dd're({s Expiration Date 1 Allure (� e �.(,U T&epho2-0200 Nre Telephone 9.Redstered Nome Improvement Contractor. _ _ Not Applicable D Wesley Couture 175982 Company Name Registration Number American Installations 6/27/17 Address Expiration Date 130 College St., Ste 100 South Hadley, MA 01075 Telephone413-552-0200 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 fli No 0 11. -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 bomeovmerto 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.. 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 SI 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 be/she shall be responsible for all such work performed under the building permit As acting Construction Supervisor yew 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 Sahlgforperson(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 1,11 iatIO! rARSMART OF BUZZ DING ZFSflCSTORS 212 Mein Street • Municipal Building Q44. `- .�,•:.._ tierthampton, q. 01060 Property Address: 239 Brookeside Circle Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley,MA Phone: 43-552-0200 Property Owner Name: lune Savino &Jill Sniadach Address: 239 Brook€side Circle 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. Con 7, Lure avtc ft Date 4/3117 9' tonrtnm �i]i~ ww.AmeManlnso BBB. CfPfettatel • licensed&IOSure8 MA CSL N 106178 American Installations MA Registration Y 175982 1]5982 130 College Street Suite lm,South Hadley.MA 01075•Office:(4131 552-0200 Fax:1413)552-0202•Email:support@AmemmnlnstallMbns.wm Savino&Sniadach,June&Jill 3/28/2017 239 Brookeside Circle Florence MA 01062 (413)586-0536 lana w�I ImI ire) Reef 448 047 17-0693 wit Quantity Unit Unit Cost Total Alr/Duct Sealing AIR SEALING 12 man hour $ 85.00 $ 1,02000 WEATHERSTRIP DOOR&ADD SWEEP 2 each $ 80.00 $ 160.00 WEATHERSTRIP DOOR 1 each $ 58.00 $ 58.00 Air/Duct Sealing $ 1,238.00 Air/Duct Sealing Incentive $ (1,020.00) Air/Duct Selaing WX Balance $ 218.00 Weatherization BASEMENT-INSULATE BULKHEAD DOOR&INSULATE 1 each 110.00 $ 110.00 CRAWI$PACE WALL RIO RIGID BOARD 77 each 4.05 $ 311.85 OVERHANG-10"DENSE R-32 CELLULOSE 38 gift 4.00 $ 152.00 ATTIC DAMMING-R-38 FIBERGLASS 155 sqk 2.05 $ 317.75 ATTIC FLAT-10"OPEN R-37 CELLULOSE 1,352 wit 1.56 $ 2,109.12 VENTILATION CHUTES 104 each 2.50 $ 260.00 ATTIC HATCH-SEAL&INSULATE 1 each 60.00 $ 60.00 INSULATED BATH EXHAUST HOSE 2 each 60.00 $ 120.00 Air/Duct Sealing WX Balance 1 lump sum $ 218.00 $ 218.00 REMOVE INSULATION 50 soft $ 075 $ 37.50 Total Weatherization $ 3,696.22 Weatherization Incentive $ 2,000.00 Total Project $ 4,716.22 Total Utility Contribution $ 3,020.00 Total Customer Contribution $ 1,696.22 WARRANTY:American installations,erste provide the above stated homeowner with a z year workmanship sea mnty Arne!Man installations,tic hereby proposes to furnish all mate heeln.l and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulation tame Total Contract Value as awed ACCEPTANCE OF PROPOSAL.The above prices specifications and TOTAL CONTRACT VALUE= $ 1,696.22 conditions satisfactory and are hereby ated You authormdto do work as specified.Payment will be 1/3 down prior to Down Payment= $ 565.00 03/28/17 start of work,end balance due upon Completion et Balance Due Upon Completion= $ 1,131.22_ aw.e i / 3w/// 4 y.( (�� Wyatt ,..�� taw128/17 fee n� ue elel S\ZJ .R.„..VIer) w.l/24'2] THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS"COMPANY",AND THE CUSTOMER(S)NAMED ON THE REVERSE SIDE,HEREINAFTER REFERRED TO AS"CLIENT",AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCALJURISDICTIONS. 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. 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(1-1/2) PERCENT PER MONTH.(18%PER ANNUM)WITH A MINIMUM CHARGE OF$2.00 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 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 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 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. 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 SOLEY DUE TO THE COMPANY'S NEGLIGENCE. 8. 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. 9. 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 PRE-EXISTING 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 PROBLEM(S) 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 AS A RESULT OF ANY KNOWN OR UNKNOWN MOISTURE 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 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 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 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 AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND D0 NOT SURVIVE THE EXECUTION OF THIS AGREEMENT. 17.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(5)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 LIABLE FOR DAMAGES FOR THE GREATER OF THE COMPANY'S ACTUAL 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 5%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 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 TIME. 22. IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCEBILITY OF THE REMAINING PROVISIONS OF THIS 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 24. ANY DISCOUNT,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 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 SAVES ENERGY PROGRAM. 26.CLIENT IS REPSONSIBLE FOR THE PAYMENT OF ANY AND ALL FEDERAL,STATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AGREEMENT. The Commonwealth of Massachusetts a c�= q Department of Industrial Accidents VI_=': Office of Investigations f. n= 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): American Installations,LLC Address: 130 College Street,Suite 100 City/State/Zip: South Hadley,MA 01075 Phone#: 413-552-0200 Are you an employer?Check the appropriate box: Type of project(required): I.❑x I am a employer with 31 4. ❑ I am a general contractor and I 6. LI New construction employees(full and/or pan-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.I 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.5 Plumbing repairs or additions myself.[No workers comp. c. 152,§I(4),and we have no 12.5 Roof repairs insurance required.]r employees.[No workers' camp.insurance required.] 13.®Other Insulation •Any applicant Mw checks box tlI must also fill out the Lection below showing their workers'compensation policy information. t Ihomeowners who submit this affidavit indicating they arc doing all work and Nen him outside oumsacmrs mini submit a new airidayit indicating such. :Contractors that diva this box must attached an additional sheet showing be mm of the sub-contractors and Nen workers'comp policy information. l am an employer that is providing workers'conpensaaon insurance for my employees. Below is the policy and job site information. Insurance Company Name: Guard Insurance Companies Policy dor Self-ins. Lie.tt:((��AMWC731485 Expiration Date: 09/04/2017 Job Site Address: 2. 2fl0\KsSq 0- C rC It. City/State/Zip: Flo CC nCt., ,W4, ©t06 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceemfy under the pains and/Jpenalties of perjury that the information provided above is true and correct. $ianature: S/�j//IalL ad:frulity-Lc . Date: LI/3'I r Phone 4:/ (� 413-55200 / 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): I. Board of Health 2.Building Department 3.City/fown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A oRd CERTIFICATE OF LIABILITY INSURANCE estINIS 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 MEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,subject to OM 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 andorsement(s). M OOIJC N Linda Po were SW Webber & Grinnell ir'reIfilEA,,. (413)586-0111 FAX ax.Net(613)586-6191 8 North Ring Street A ,1powersewebberandgrinnall.cam ---__ eaufwa 1AFFORD I INKS... COVERAGE Northampton HA 01060 INSURER A 3111p1OY0rs Mutual Casualty IHBIMFA INSURER a Berkshire Hathaway GMBH Ins. Co. American Installations, LLC 0X8014710: Attn: Wee G Suzanne Couture INSURER!): 130 College Street, Suite 100 INSURERS: South Hadley WS 01075 Weems F: _.. ..._- COVERAGES CERTIFICATE NUMBERWaeter Rap 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. NOTYATHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT KITH 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.OATS SHOWN MAY HAVE BEEN REDUCED BY PAIDAIGAMS. L114 TATE OF INSURANCE qn 1 F Il Paycy NORMS Y dZncY1'1 pall COMNHKML OMEML LIABILITY EACH OCCURRENCE 1,000,000 A X CLAIMSauDE OCCUR MMAGETDaEMEO 500,000 NDGETORE*p con) X Lieuer_ldabili02 1503435217 9/4/2016 9/6/2017 MED EXP(Arlo-apemen) 10,000 _ PERSONAL 4AOV INJURY 1,000,000 GENL AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE 2,000,000 J47277 X POLICY_ 1 LCC PRODUCTS•CCMPOP AGO 2,000,000 OTHER: • AUTOMOBILE LABILITY COMBINED SINGLE LINT 1,000,000 s AE_e a�P.O_ A ANY AUTO BODILY INJURY IPM Pawn) UTGOS EO R•WJ LFD OS 5E3535217 9/4/2016 9/4/2017 BODILY INJURY(PF,bee NONOMNEO '-•PERTY DAMAGE X XIREO Al1TQ5 X 1AUTos President) PIRBesr 8,000 UMBRELLA OAS —OCCUR EACH CCCLJRENCE S 1,000,000 A EXCESS CLAIMS-MADE AGGREGATE S 1,000,000 'DED X RETENPON I 10,000 533535217 9/4/2016 9/4/2017 S :WORKERS COMPENSATION a PER 0T RH- ANDEMOYERSLIA 1TY • STATURE FR ANY PR0PRIETOILPARTNEREXECLRNE YIN E_L._EACHAC_GOEM_ $ 500,000 OFFICER/MEMBER EXCLUDED? B NIA - mandator/MNN1 ORNC609917 9/4/2016 9/4/2017 E.L DISEASE-EA EMPLOYEE S 500,000 IM M vide I DESCRIPTION OF OPERATIONS WM E.L DISEASE-POLICY LIMIT I$ $00,000 A Co ercial Property 15a3535217 9/4/2016 9/4/2017 Mr2ILY4I W. $20,000 6Mi1NeSI UN $40,000 DESCRIPTION Of OPERATIONS 1 LOCATIONS I VmWCLEE ARD 101.Additional MIME,i[ItlIM.my M YhNtl id men spies M,giMl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS. AOTHORIZED REPRESENTATIVE Kevin Joyce/LMP ®1988.2014 ACORD CORPORATION. All rights ressrnd. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 opium Massachusetts-Department of Public Safety Unrestricted-Buildings of any use group which Board of Building Regylations and Standards contain less than 35,000 cubic feet(99Imr)Of Com:rucnon Supervisor enclosed space. License: CS-106178 fTIF b, WESLEY CO U'1'IrJtE �' 166 NORTH MAW Sian, -f- South Hadley MA`=01 `,. Failure to possess a current edition of the Massachusetts n ra State Building Code is cause for revocation of this license. ¶74 `rriExpiration Commissioner 09/29/2017 Far rtes Nceising Information visit wwwMass.cov/ort LN �e ?okra Y z V afro Office of Consumer Affairs and Busi- ss Reg'iation ...15.1=1- —WA Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 175982 Type: LLC Expiration: 6/27/2017 Tiff 265208 AMERICAN INSTALLATIONS, LLC WESLEY COUTURE 130 COLLEGE STREET SUITE 100 SOUTH HADLEY, MA 01075 Update Address and return card.Mark reason for change. scat 0 201A4/5/11 - E Address LI Renewal Ll Employment 0 Lost Card hJ6er` onin,o.,.eea&/.f'04/1aod,/,atLs _t Office of Consumer Affairs&Business Regulation License or registration valid for individul use only gOify ,"OME IMPROVEMENT CONTRACTOR before the expiration date. If ound return to: t lli_ ;egistrabon: 175982 Type: Office of Consumer Affairs and Business Regulation I I" 10 Park Plaza-Suite 5170 � .z Expiration: 6278017 LLC Boston,MA 02116 AMERICAN INSTALLATIONS,EEC WESLEY COUTURE d:,.. , /r 130 COLLEGE STREET.SUITE 100 ,t_„a Y..<.— — SOUTH IiADLEY,MA 01075 _—r Undersecretary N valid without signature