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17A-117 (3) 22 CLAIRE AVE BP-2020-1034 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 117 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-2020-1034 Proiect# JS-2020-001746 Est.Cost:$2906.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot size(sq.ft.): 9016.92 Owner: YOUNG HOLLY Zoning: RI(100)/URA lOoZ �plicant: AMERICAN INSTALLATIONS LLC AT. 22 CLAIRE AVE Applicant Address: Phone: Insurance: 130 COLLEGE ST (413)552-0200 WC SOUTH HADLEYMA01075 ISSUED ON.311612020 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 3/16/2020 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner DepdEm City of Northampton Building Department- 6 212 Main Street , Room 100 � < SULA TION ,�n?�� n� 1� Northampton, MA 01060 ps1¥ x 'ONLY hone 413-587-1240 Fax 413-587-12 o ax APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULA TION PERMIT 1.1 Property Address: This section to be completed by office 22 Claire Avenue Map 14 Lot �l—7 Unit Florence,MA 01062 Zone_ Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Holly Young 22 Claire Ave, Florence, MA 01062 Name(Print) Current MailinAddress: See attached Te4133209025 lephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, AIA 01075 Name(Print) Current Mailing Address: (413)552-0200 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2906.75 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number / This Section For Official Use Only to Building Permit Number: �)q Dat ed: Signature: 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 9/29/2021 Address Expiration Date (413)552-0200 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ American Installatiow 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 6%26/2021 Address Expiration Date Telephone (413)552-0200 SECTION 5-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S)) 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....... JV No...... ❑ Brief Description of Proposed Work NO TE: INS ULA TION ONL Y Attic and basement insulation and air sealing throughout. 1, American Installations- Wesley Couture as Owner/Authorized ,Agent hereby dcclar that the statements and inforat on on the foregoing application are true ana accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Wesley K. Couture Print Name Signature of Owner/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 Signature of Owner Date City of Northampton - Massachusetts N �- DEPARTMENT OF BUILDING INSPECTIONS ?' z 212 Main Strout • Municipal Building V`,, Cam Northampton, MA 01060 r��_ .... .�� 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: $2906.75 Address of Work: 22 Claire Ave, Florence, MA 01062 Date of Permit Application: 03/11/2020 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 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 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: 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 SS S� f/ •''f Massachusetts ( } DEPARTMENT OF BUILDING INSPECTIONS y: - 212 Main Street *municipal Building Northampton, MA 01060 J,SN�y"uj 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: 22 Claire Avenue: Florence. MA 01062 (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: (Company Name and Address) Signature of Permit 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 Massachusetts t AW DEPARTMENT OF BUILDING INSPECTIONS y. 212 Main Street • Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address. 22 Claire Ave., Florence, MA 01062 Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner Name: HollyYoung Address: 22 Claire Avenue City, State: Florence,MA 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 DocuSign Envelope ID:3265128F-651E-4501-9AC4-D15AF4247077 Federal ID#05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 RISE60 Shawrnut Road,Canton,MA 02021 CONTRACT YYZ 339-502-6335 X-7109 FAX 339-502-6345 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT p WORK ORDER Holly Young (413)320-8025 12/05/2019 461086 00004 SERVICE STREET BILLING STREET 22 Claire Avenue 22 Claire Avenue SERVICE CrTY.STATE.ZIP BILLING CITY.STATE.ZIP Florence. MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL VERMICULITE HAZARD We have noted there is Vermiculite insulation in your home. Vermiculite might contain asbestos fibers,which is a known carcinogen. Weatherization measures,such as air sealing and insulation,cannot be installed in the areas of your home where vermiculite is present. To prevent disturbance of the vermiculite, a blower door test will not be conducted at your home. ATTIC FLAT- 14"OPEN R-49 CELLULOSE 960 51,728.00 $1,728.00 Provide labor and materials to install a 14"layer of R-49 Class I Cellulose to open attic space. ATTIC HATCH:SEAL&INSULATE 1 $60.00 $60.00 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board. Weatherstrip the perimeter. VENTILATION CHUTES 60 $150.00 $150.00 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. VENT BATH FAN THRU ROOF 4 INCH 1 $118.75 S118.75 Provide labor and materials to install an insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). HOME AIR SEALING 10 $850.00 $850.00 Provide labor and materials to seal areas of your home against wasteful,excess air leakage. Materials to be used o seal your home can include caulks.foams and other products. Primary areas for sealing include air leakage to attics.basements, attached garages and other unheated areas (windows are not generally addressed.) A reduction in cubic feet per minute(cfm)of air infiltration will occur, but the actual number of cfm is not guaranteed. At the completion of the weatherization work, and at no additional cost to the homeowner, a final blower door and/or combustion safety analysis will be conducted by the sub-contractor. DocuSign Envelope ID:3265128F-651E-4501-9AC4-D15AF4247077 Federal ID t/05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 RISE /iCj— 60 Shawmut Road,Canton,MA 02021 ENGINEERING CONTRACT - WZ 339-502-6335 X-7109 FAX 339-502345 Page 2 PROGRAM THIS CONTRACT ISENTERED INTOBETWEENRISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT WORK ORDER Holly Young (413)320-8025 12/05/2019 461086 00004 SERVICE STREET BILLING STREET 22 Claire Avenue 22 Claire Avenue SERVICE CRY,STATE ZIP BILLING CITY STATE.ZIP Florence. MA 01062 Florence, MA 01062 DESCRIPTION QTY COST INCENTIVE TOTAL I -INCENTIVE: 75% For eligible measures, Columbia Gas of Massachusetts is offering an incentive of 75%, with no limit, and an incentive of 100% for the Air Sealing measures up to$1,020 Total: $2,906.75 Program Incentive: $2,906.75 Customer Total: $0.00 WE AGREE HEREBY TO FURNSH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***001 Dollars $0.00 UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF I%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. �DOC S,gncd by. Doc I igned by: v1S 4.14 EREPRESEATATtO D78303H73AB444H 12/5/2019 1 3:55 PM EST NOTE:THIS CONTRACT MAYBE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE 30 DAYS. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES.SPEC IFICARONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADEAS OUTLINED ABOVE 11 The Commonwealth of Massachusetts Department of Industrial Accidents a a I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le:?iblY Name (Business/Organization/Individual): American Installations, LLC Address: 130 College Street, Suite 100 11.1 City/State/Zip: South Hadley, MA 01075 Phone#: 413-552-0200 _ Are you an emplover?Check the appropriate box: Type Of project(required): 1.®[am a employer with 70 employees(full and/or part-time).* 7. ❑New construction 2, 1 am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.(No workers'comp.insurance required.)' 10[]Building addition 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1-hese sub-contractors have employees and have workers'comp.insurance.t 13.Q Root repairs 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 below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire 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 informadon. Insurance Company Name: Berkshire Hathaway GUARD Policy#or Self-ins.Lic.#: AMWC049875 Expiration Date: 09/04/2020 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation 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 informationprovided above is true and correct. I Si nature: Date: 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 Person: Phone#: Commonwealth of Massachusetts Construction Supervisor Division of Professional Licensure Unrestricted -Buildings of any use group which contain Board of Budding Regulations and Standards less than 35,000 cubic feet (991 cubic meters) of enclosed Construction Supervisor space. CS-106178 E>Kp i re s: 09129/2021 WESLEY COUTURE 139 PACKARDVILLE ROAD PELHAM MA 01002 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 W Call (617) 7273200 or visit www.mass.gov/dpl 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 Return Card. sin 1 a 11W-W17 Office of Consumer Affairs 8 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 0211 B WESLEY COUTURE 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075Undersecretary l Not valid without signature AC� CERTIFICATE OF LIABILITY INSURANCE °A72 ) 8�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 CONTACT Linda Powers NAME: Webber & Grinnell PHONE (813)586-0111 FAX 413)586-6481 A/C No xt: A/C,No 8 North King Street E-MAIL ADDRESS: /powers@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A:Employers Mutual Casualty INSURED INSURER B:Berkshire Hathaway GUARD Ins. Co. American Installations, LLC INSURER C: Attn: Wes & Suzanne Couture INSURER D: 130 College Street, Suite 100 INSURERE: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 MMIDDIYVVV MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X CLAIMS-MADE FlOCCUR DAMAGE TO RENT 500,000 PREMISES Ea occuurn rence $ 5D3535217 9/4/2019 9/4/2020 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY ❑JECTPRO F—] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS X AUTOS SZ3535217 9/4/2019 9/4/2020 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident $ X Coll$2,000 X comp$2,000 PIP-Basic $ 8,000 X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LAB 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/EXECUTIVEE.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ B N/A (Mandatory in NH) AMWC994153 9/4/2019 9/4/2020 EL DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E .DISEASE-POLICY LIMIT $ 500,000 P:llu:si:ness Personal Property 5A3535217 9/4/2019 9/4/2020 deductible$1,000 500,000 RIPTION 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 W Grinnell, CPCU, CIC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)