32C-212 (6) 41 HOLYOKE ST BP-2019-1224
GIs s: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:32C-212 CITY OF NORTHAMPTON
Wt: A01 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category,INSULATION BUILDING PERMIT
Permits BP-2019-1224
Proiect s JS-2019-001981
Est.Cost:$2600.00
Fee' S65,00 PERMISSION IS HEREBY GRANTED TO:
Const,Class: Contractor: Lkense:
Use Group: AMERICAN INSTALLATIONS LLC 10817
Lot Size(sc.R.),. 9104.04 Owner: WILLIAM SHERR
Zoni=U aR toov Aonikank AMERICAN INSTALLATIONS LLC
AT: 41 HOLYOKE ST
ADelicantAddress: Phone: Insaranre:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:51212019 0:00:00
TO PERFORM THE FOLLOWING WORMATTIC 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 X Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: 011,, 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:
FeeTyoe; Date Paid: Amount:
Building S/2R0190:00:00 $65.00
212 Main Street,Phone(4 0)487.1240.Pax:(413)587-1272
Louis Hasbrouck—Building Commissioner
� Dep
City of Northampto
Building Departme YAY
212 Main Street
Room 100 INS ULA TION
\ '
Northampton, MA 41360 —JONL Y
phone 413-587-1240 Fax Fax 41158]-17-1 272
APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY
SECTION I-SITE INFORMATION INSULATION PERMIT
1.1 Property Addriety This
section to be completed by olitee
Map — Lot -\� nit
41 Holyoke Street
Northampton, MA 01060 Zone Overlay District
Elm SL Dlimct CB DWakt
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Sherr,William PO Box 716 Northampton MA 01061
Nam(PMt) Cunemmalln Apdreaa:
See attached (917) 61 -6276
Telephone
Siure
2.2 Authorized Apart:
American Installations 130 Colleze Street Ste. 100, South Hadley, MA 01075
Name pedro Ckmr4 Maio Addax:
tl x k, CASUE A 3 , (413)552-0200
Si2neWre Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Esgmeted Cost(Dollar)to be Official Use Only
complethadby mitapol,cant
1. Building $2,600.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from e
3. Plumbing Building Permit Fee
6o
s. Mechanical(F1VAC)
5.Fra Protection
6. Total-(1+2+3+4+5) $2,600.00 Check Number
This Section For ORlcld Use On
Date
Build ng Permit Number. Issued:
Signature: 5 1-ZDIq
BUM"Commissionernmpedw of&eMNgs Data
production @americaninstallations.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. Not Applicable Cl
Name of Lice..Nolder Wesley K. Couture 106178
License Number
130 College Street Ste. 100, South Hadley MA 01075 9/29/2019
Addreaa EvirNbn Date
WaAQa.w 14131552-0200
agnNua Telephone
S,Repletentl Name anow"mnd Contractor. Not Applicable O
American Installations 175982
Company Name Registration Number
130 College Street Ste. 100, South Hadley MA 01075 6/26/2019
Address Expiration Date
W D gD Q 1V� cm � Tslephone (413)552-0200
SECTION e-WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.182,§25CIS))
Worlass,Compensation Insurance affidavit must be completed and subma0ed with this application.Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Ves_._.. X No...... ❑
Brief Descriptlon of Proposed Work NOTE: INSULATION ONLY
Attic insulation and air sealing throughout.
1, American Installations -Wesley K.Couture as OwnerfAuthorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the beat of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Wesley K Couture
PM1M Name
I U n In 4/29/2019
gignature nAgenl Data
I, Sherd William as Owner of the subject
property
hereby authorize American Installations
te act on my behalf,in all matters nslatite to work authorized by thro building permit application.
See attached 4/29/2019
Signal=of Owner Dale
City of Northampton
/ -
Massachusetts
�•I DEPARTMENT OF B=ZDIBO XMITSCTIOW �!
212 Main 6trMt " Bmlelpal�. aaildi,q C 9acthu ton, M 01060`
C
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prim to
performing work on such homes,a contractor must be registered as a Home Improvement Contract"("HIC").
M.G.L.Chapter 142A requires that the"reconstruction,aderelion, renovation,repair,modemindon,conversion,
improvement,removal, demolition,or construction of an addition to any preexisting ownereccupkrd building containing
at least one but not more than lona dwelling units....or to structures which are adjacent to such residence or budding"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: Insulation Est Cast: $2,600.00
Address of Wmk 41 Holyoke Street Northampton,MA 01060
Date of Permit Application: 4/29/2019
I hereby certify that:
Registration is not required for the following reas au(s):
_Work excluded by law(explain):
—Job under S1,000.00
_Owner obtaining own permit(explain):
Building not ownaocwpied
x Other(specify): Contractor pulling permit for homeowner
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 14M SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury
I hereby apply fm a building permit as the agent of the owner.
4/29/2019 American Installations 175982
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts
212 Miner or em Rica assacr�
aix wtu attest .wtiac i suis
sotcx..ipco., w aaoso
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
41 Holyoke Street
(Please prim house number and street name)
Is to be disposed of at:
Waste Management of New England, Chicopee, MA 01020
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
1 (-Company Name and Address)
�L V, fC_ Cautunx �J f9 b 9
Signature ciffemrift Applicant or Owner Date
If,for any reason,the debris will not be disposed of as indicated,the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
— City of Northampton
NF
r F
Massachusetts
4
➢ a OP a4IIDIMl n
212 wn at . . auaBuilding
aarth@ton, NX 01060 jCL.>e
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: 41 Holyoke Street Northampton, MA 01060
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley MA
Phone: (413)552-0200
Property Owner
Name: William Sherr
Address: 41 Holyoke Street
City, State: Northampton
1, Wesley K. Couture (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 , \QIAA r �
Date NV
4/29/2019
me
mase
Meca,:lain
PARTNER
American Installations M` .M11mericanimbilialom..
SL[ab3a Sbe,l Siae1W.5WM NJF.MP W WS•OK e:Mi3133LOWOM:la1N Ri-VIDE a Sana aupNl(MwLkaMY6tlmt[m
Customer Name:William Sherr
Emall:Not provided
Phone:917 613 6276
Premise Address:41 Holyoke SI,Nonhamplon,MA 01060
Melling Addnsee:41 Holyoke St,Northampton,MA 01060
Project to:3789851
Data:April 3,2019
Job Description
Measure Description Location Quantity Unit Total Cost Customer Cost
Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 8 hr $740.64 $0.00
Door-2'Thermal Barrier Polyiso Living Space 1 each $90.44 $22.61
Vapor Barrier-6 mil Polyethylene(with AS hrs) Living Space 384 SF $376.32 $0.00
Hatch -2"Thermal Barrier Polyiso Living Space 2 each $92.56 $23.14
Attic Floor-4'Open Blow Cellulose Living Space 768 SF $1,136.64 $284.16
Damming Living Space 44 each $105.16 $26.29
Project Total $2,541.76
Weatherization incentive ($1,068.60)
Air sealing incentive ($1,116.96)
Total Program Incentive -$2,185.56
Customer Total $356.20
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xccB+Bvcl or Bno=mnL: -ry amF eKF. We[iraxona ,m [.tiem e.e .orucoer3a .iff•s 356.20
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The Commonwealth of Massachusetts
Department of Industrial Accidents
_ Office of Investigations
600 Washington Street
Boston,MA 01111
www.tnars.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Letdbly
Name(Bacenes„orgw,i,aliodlaai.iadel : American Installations,LLC
Address: 130 College Street,Suite 100
City/State/Zip: South Hadley,MA 01075 Phone 9: 413-552-0200
Are you an employer?Check the appropriate box: Type ofprojeel(required):
L N 1 am a employer with 60 _ 4. ❑ 1 am a general contractor and t 6. ❑New construction
employees(full and/or part-0me).0 have hired the subcontractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑Remodeling
ship and have no employees These subcontractors have S. ❑ Demolition
working for mein any capacity. workers'comp.insurance. 9. E]Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its
required.[ officers have exercised their III.[]Electrical repairs w additions
3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions
myself.(No workers'comp. c. 152,§I(4),and we have no 12.❑ Rnifrepairs
insurance required.(f employees.[No workers' 13 ®Other_ Insulation
comp. insurance required.[
'Ary Wit,anl alai chacks Wait Iswa alio fill not tae amama below shnwmg thew wam
ter; m,coanolon Wbf t
rt inion.
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10
he who suburb low uffdavil indicating they ore doing all work and Ihen him ov aide...mactom wool sumit bn new aflm.vf indlcaling such.
Cownelom Nkl clxvk ars box nail Marched an edilioml area dewier he name of the subcomonwa and new workrn'camp.116 ,alfowni
I am an employerthm is pmvWng workers'compemation imurmeefur my empioyeec Below is the policy and jab site
informmioa
Insurance Company Name: Guard Insurance Companies
Policy dor Self-insl.�Lic.h: URWC609917.-___._._. Expiration Date: 09/04/2019
Job Site Address: LI W'44" 'E�01 City/State/Zip:
Attach a copy of the workers'coLiptionation policy declaration page(showing the policy number and eapration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition ofcriminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,is well as civil penalties in the form of a STOP WORK ORDER and a fine
ofup m S250.0o a day against the violatw. Be advised that a copy of this statement maybe forwarded to the Office of
Inves6gatiuns of the DIA for insurance coverage verification.
I do hereby certify underthe pains annd portables of perjury that the information provided above is true and correca
Sieuawre: ,d/B.tkk- Q. l _. Date:
Phone a: 413-55 -0200
Official use aptly. Do not write in this arca,to he completed by city or town a lefal
City or Towle Peratit/Liamew h
Issuing Authority(eirek one):
1. Board of Health 2. Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Perron: Phone a:
_ Camwnweanh of Massachusetts Construction supervisor
®' Division of Professional Lnensure Unrestricted-Buildings of any use group which contain
Board of Building Regulations and Standards less tM 36,000 cubic feet(991 cubic meters)of enclosed
Construction Supervisor space.
CS-106178 Eapires: 09/29/2019
VVESUEY COUTURE
218
210 LATHTHROSTREET
SOUTH HADLEY MA 01075
Phareto ilding Code
is crus edition of to Massachusetts
State Building Code is cause for revocation of
this lcense.
Far 7oabout this license
Commissioner Call(617)774200 r
visa v]ww.nass.gov/dpi
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvemeflt Contractor Registration
Type: LLC
AMERICAN INSTALLATIONS,U.C. Registration: 175982
130 COLLEGE STREET SUITE 100 E>�iratlon: 08/2812019
SOUTH HADLEY,MA 01075
Update AOdressarY ralun urd. Yank rMsan for ahenga.
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IMPROVEMENT
CONTRACTOR
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before Mbnvalld for individual duond rely
TYPE:LLC before f Consumer
Alter adBusieturn to:
�;\ur Reolstralan Expiration Oman, Conwmereclairs and Business Regale[ion
1]5902 Oft@8/2019 10 PaM taxa-Supe 6170
AMERICAN INSTALLATIONS,LLC. Boston,MA 02116
WESLEY COUTURE
ISO COLLEGE STREET SUITE 100
SOUTH HADLEY,MA 01075 Undersecretary t t valid without signature
A�De CERTIFICATE OF LIABILITY INSURANCE Fears lWO —
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMMO, E 11) 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
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COVERAGES CERTIFICATE NUMSERWetar Zay 9-2019 REVISION NUMBER:
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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,
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WOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
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ACCORDANCE WITH THE POLICY PROVISIONS.
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O 1988-2016 ACORD CORPORATOR All d"reserved.
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