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34-030 (10) 124 TURKEY HILL RD BP-2020-0835 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:34-030 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 P E RM I T Permit# BP-2020-0835 Project# JS-2020-001440 Est.Cost: $9963.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sg. ft.): 309319.56 Owner: GORIN DAVID zonine: Applicant. AMERICAN INSTALLATIONS LLC AT. 124 TURKEY HILL RD Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.112712020 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 Siginature: FeeType: Date Paid: Amount: Building 1/27/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 3-415 Dep " iaF City of Northampton Building Department 212 Main Street .,INSULA TION ! � k Room 100 x g Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 �ir. ONLYx 5 APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address: This section to be completed by office Map - Lot _Unit 124 Turkey Hill Road Zone Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: David Gorin tip Katherine Mullen 124 Turkey Hill Road Name(Print) Current MailinAddress: See attached (510) 5$0-2323 Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: I)OV-I'm �- r%& (413) 552-0200 Signature j Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 9963.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee //// /�► 4. Mechanical(HVAC) (,•/�/ ' Q� 5. Fire Protection vvv 6. Total=(1 +2+3+4+5) 9963.00 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: aZd Building Commissioner/Inspector of Buildings Date production @ americaninstallations.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Wesley K. Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 912912021 Address Expiration Date L)pk-h �dlj�D (413) 552-0200 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 612612021 Address Expiration Date Telephone (413) 552-0200 SECTION 5-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8)) 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....... J1 No...... ❑ Brief Description of Proposed Work NO TE: WS ULA TION ONL Y Attic and basement insulation and air sealing throughout. I, American Installations - Wesley Couture as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Wesley K. Couture Print Name L )LLM �, C(AJA'IJ 1/17/20 Signature of Owne Agent Date I, , as Owner of the subject property hereby authorize American Installations to act on my behalf, in all matters relative to work authorized by this building permit application. See attached 1/17/20 Signature of Owner Date City of Northampton ✓ Massachusetts `E DEPARTMENT OF BUILDING INSPECTIONS _ ;m 212 Main Street • Municipal Building %) ta! Northampton, MA 01060 �s6jr �1a. 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. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"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. Cost: 9963.00 Address of Work: 124 Turkey Hill Road Date of Permit Application: 1/17/20 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied x Other(specify): Contractor ulling 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 142A.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 for a building permit as the agent of the owner: 1/17/20 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: 1/17/20 1A �m&i V. CmAlm i Date Owner Name Ad Signature City of Northampton Massachusetts c t' DEPARTMENT OF BUILDING INSPECTIONS x yJ, a y 212 Main Street *Municipal Building � p Northampton, MA 01060 sry ;.-. �a Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, 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: 124 Turkey Hill Road (Please print 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: American Installations (Company Name and Address) Signature of Per it 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 t� Massachusetts ' N. s / DEPARTMENT OF BUILDING INSPECTIONS J 212 Main Street • Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 1211 urkey Hill 1,. Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner David Gorin &Katherine Mullen Name: Address: 124 Turkey Hill Road City, State: Northampton,MA 01062 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 Date 1/17/20 Page 1 of 2 • mass save Licensed&insured PARTNER MA CSt N:706178 , MA RegnirotNon a 175982 American Installations www.AmericanInstallations.com 130 College Street Suite 100,South Hader,MA 01075•Office:(413)552-0200 Fax:(413)552-0202• Email, supportLOAmericaninstallations.com Customer Name:David Gorin Email:Not provided Phone:510-590-2323 Premise Address: 124 Turkey Hill Rd,Northampton,MA 01062 Mailing Address:124 Turkey Hill Rd,Northampton,MA 01062 Project ID:3952943 Date:Dec. 19,2019 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Exterior Door Weather Stripping (with AS hrs) 2 each $60.14 $0.00 Door Sweep (with AS hrs) Living Space 2 each $50.62 $0.00 Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 2 hr $185.16 $0.00 Attic Stair Cover w/Carpentry (with AS hrs) Living Space 1 each $289.31 $0.00 Kneewall Wall - 2"Thermal Barrier Polyiso Living Space 913 SF $4,364.14 $1,091.04 Kneewall Floor- 7"Open Blow Cellulose Living Space 303 SF $509.04 $127.26 Cut and Finish Access Living Space 9 each $1,120.77 $280.19 Kneewall Wall -6" Fiberglass Batting Living Space 824 SF $1,755.12 $438.78 Kneewall Slope -2"Thermal Barrier Polyiso Living Space 156 SF $745.68 $186.42 Transition Air sealing 129 LF $882.36 $0.00 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope o`work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE Or PROPOSAL: The above prices, speci"ications and conditions are TOTAL CONTRAC-VALUE- 5 satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment=5 ❑ will be 1/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion= S Signaiturc Date Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date THIS AGREEMENT IS COMPOSED OF THIS PAGE AND 7 H REVERSE TOE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BV TME CAIn IES INVOLVED THIS AGREEMENT IS BETWEEN AMERICAN I NST ALIATIONS,LLC HEREINAFTER REFERRED TO AS-COMPANY', ANDTHE CU57014ENJ SI NAMED ABOVE,HEREINAFTER ROBIN RED TO AS*CLIENT'.AND WILL BE SIA IEC7 TOALL APPROPRNTE LBWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSAOIUSET IS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL TU RISOICTR)NS Page 2 ofR2 • mass save Licensed&insured PARTNER MA CSt N:206178 , MA Regisrrnnon IN 17598) American Installations www.AmericanInstallations.com 130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)SSZ-0200 rax:(413)552.0202 • Email:supp(wt@AMeficanlnstallations.com Customer Name:David Gorin Email:Not provided Phone:510-590-2323 Premise Address: 124 Turkey Hill Rd,Northampton, MA 01062 Mailing Address: 124 Turkey Hill Rd,Northampton,MA 01062 Project ID:3952943 Date:Dec. 19,2019 Project Total $9,962.34 Weatherization incentive ($6,371.06) Air sealing incentive ($1,467.59) Total Program Incentive -$7,838.65 Customer Total $2,123.69 WARRANTY:American installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American installations,LLC hereby proposes to furnish all material and labor to Complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE O,- PROPOSAL: The above prices, specifications and conditions are TOTA-CONTRACT VALUE-s 2123.69 satisfactory and are hereby accepted.You are authorized to do work as specified.Payment 700.00 will be 1/3 down prior to start of wore,and balance due upon Completion. Down Payment=S PAID Balance Due Upon Completion= S 1423.69 Signature �'-- Date Property Owner(Print) Gorin,David (Sign) Date Representative:(Printl Jason Bhalan (Sign) Date TFIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENURE AGREEMENT BR THE PARTIES PRI LVED TNI$AGREEMENT 15 BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS'COMPANN'. A NO THE LUSTOMER(S)NAMED ABOVE,HEREINAFTER REFER REO ICA S-UIENT',AND WILL BE SUBJECT TO ALL APPROPRIATE LA WS.REGUTA-IONS AND ORDINANCES Of THE STAR OF W 5SAOIUSET TS OR CONNECTICUT RE5PEC7IVELT.ASW ELL AS ALL LOCAL JUASOI CIONS 11 The Commonwealth of Massachusetts - Department of Industrial Accidents s 1 Congress Street,Suite 100 Boston, MA 02114-2017 r' www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FiLED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (BusinessiOrganization/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?Cheek the appropriate box: Type of project(required)' I.®i am a employer with 70 employees(full and/or pan-tune)." 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. [:]Remodeling any capacity [No workers'comp.insurance required.] 9. ❑Demolition 3 F-1 i am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 wilt ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.L]Plumbing repairs or additions 5.F-J!am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs I hese sub-contractors have employees and have workers'comp.insurance.t 6.Q we are a corporation and its officers have exercised their right of exemption per MGL c. 14.©Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#I must also fill out the section Wow showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Berkshire Hathaway GUARD _ Policy#or Self-ins.Lic.#: A rM,WyC049875 Expiration Date: 09/04/2020 �l/i I l I l 1� Ci OI�IfJIJ Job Site Address: ty/StatelZip Attach a copy of the workers'compensa 'on policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 providee abovf is true and correct. Si nature: Date: 14 11J Phone#: 413-552-0 00 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): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other-------- Contact ther-- ---Contact Person: Phone#: Commonwealth of Massachusetts Construction Supervisor Division of Professional Licensure Unrestricted -Buildings of any use group which contain Board of Building Regulations and Standards less than 35,000 cubic feet (991 cubic meters) of enclosed Construction Supervisor space. CS-106171 =upares ,9+29/2021 WESLEY COUTURE 139 PACKARDVILLE ROAD PELHAM MA 01002 S ti Failure to possess a current edition of the Massachusetts } State Building Code is cause for revocation of this license. Commissioner For information about this license Call (617) 727-3200 or visit www.mass.gov/dpl 00 4w/ Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 175982 AMERICAN INSTALLATIONS,LLC. Expiration: 06/26/2021 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Reb_;rn Card. SGA t O M-05117 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. if found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 175982 06/26/2021 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 02118 WESLEY COUTURE 130 COLLEGE STREET SUITE 100M�G:'s�. r ZT, SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature TE A�R" CERTIFICATE OF LIABILITY INSURANCE FDA8/28/2019) THIS CERTIFICATE IS ISSUED ASA 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 Linda Powers NAME: Webber b Grinnell PHONE (413)586-0111 FAX c413l5e6-6481 No,ExflA/C No 8 North King Street E-MAIL 1powers@webberandgrinnell.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA:Employers Mutual Casualty INSURED INSURER B:Berkshire Hathaway GUARD Ins. Co. American Installations, LLC INSURERC: Attn: Wes S Suzanne Couture INSURER D: 130 College Street, Suite 100 INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER:Master Exp 9-2020 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DDNYYY MM/DDNYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X CLAIMS-MADE ❑OCCUR DAMAGE TORENTED 500,000 PREMISES Ea occurrence $ 5D3535217 9/4/2019 9/4/2020 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT ❑ LOC PRODUCTS-COMP/OPAGG $POLICY PRO 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A ANYAUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED SZ3535217 9/4/2019 9/4/2020 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident $ X Coll$2,000 X comp$2,000 PIP-Basic $ 8,000 iX UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 5J3535217 9/4/2019 9/4/2020 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑N/A B (Mandatory m NH) AMWC994153 9/4/2019 9/4/2020 E.L.DISEASE-FA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT 1$ 500,000 A Business Personal Property 5A3535217 9/4/2019 9/4/2020 deductible$1,000 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE q W Grinnell, CPCU, CIC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401)