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36-218 (5) BP-2023-0779 8 BIRCH LANE COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 36-218-001 CITY OF NORTHA PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0779 PERMISSION IS HEREBY GRANTED TO: Project# INSULTION 2023. Contractor: License: Est. Cost: 2800 AMERICAN INSTAL ATIONS LLC 106178 Const.Class: Exp.Date: 09/29/202 Use Group: Owner: SHEI R JOHN M&ELIZABETH A TRUSTEES Lot Size (sq.ft.) Zoning: SR Applicant: AMERI AN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC32951 SOUTH HADLEY, MA 01075 ISSUED ON: 06/13/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHERIZATI ON 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORrI'HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 51' 1 • I lI Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commiss. ner i 23-1116 �� Depp�aat� City of Northa pto e ";4 Building Depa men ✓UN 1 �, 212 Main reet i 3 ULATION i Room � �roF ° .�w 1 Northampton, MA ryq U/ro/NG phone 413-587-1240 Fax 413-58 MSpFc1., Ot'JL Y A 07 0600/yS APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT This section to be completed by office 1.1 Property Address: 8 Birch Lane Map Lot Unit Florence, MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Sheirer, John & Elizabeth 8 Birch Lane, Florence, MA 01062 Name(Print) Current Mailing Address: See attached 4133878093 Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 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 2800 (a)Building Permit Fee 2. Electrical 0 (b)Estimated Total Cost of Construction from(6) 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) #Uc 5. Fire Protection 6. Total=(1 +2+3+4+5) 2800 Check Number cit'A This Section For Official Use Only , Building Permit Number: 6,0.1 ' 7? Date' Issued: Signature: Building Commissioner/Inspector of Buildings Date permits@AmericanInstallations.com @ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Wesley K. Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 9/29/2023 Address Expiration Date (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 6/26/2025 Address ) � � Expiration Date /.// Telephone (413)552-0200 SECTION 5-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 No 0 Brief Description of Proposed Work NOTE: INSULATION 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 i �1 5/31/2023 Signature of Date I, Sheirer, John & Elizabeth , 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 5/31/2023 Signature of Owner Date City of Northampton /' '''" Massachusetts • 1- '<<, (. 1 f : ll' 1 DEPARTMENT OF BUILDING INSPECTIONS 4F , lie'-"„0 212 Main Street • Municipal Building w4:i' a� ��°� Northampton, MA 01060 P,•bfY•• %j.�1 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 1~st.Cost: 2800 Address of Work 8 Birch Lane, Florence, MA 01062 Date of Permit Application: 5/31/2023 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: 5/31/2023 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 - S w j Massachusetts ��, rh y R 6 DEPARTMENT OF BUILDING INSPECTIONS E 212 Main Street •Municipal Building Northampton, MA 01060 "rsE.;--:-%ji.\�`' 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: 8 Birch Lane, Florence, MA 01062 (Please print house number and street name) Is to be disposed of at: K& W Materials &Recycling, 138 Palmer Ave, West Springfield, MA 01089 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 5/31/2023 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 0 sic. 'r Massachusetts �� � . ,r * c 7 DEPARTMENT OF BUILDING INSPECTIONS , b 212 Main Street • Municipal Building I-,f'• � 74, Northampton, MA 01060 s 4.6-� MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 8 Birch Lane, 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: Sheirer, John & Elizabeth Address: 8 Birch Lane City, State: Florence, 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. m____ , Contractor signature pi A Date 5/31/2023 The Commonwealth of Massachusetts Department of Industrial Accidents fOffice of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 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 St, 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): 1.❑■ I am a employer with 43 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. n Remodeling ship and have no employees These sub-contractors hav 8. ❑ Demolition working for me in any capacity. employees and have work s' q 7 Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and i s 10.n Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised the r 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per M 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13.0 Other comp. insurance required.] *My applicant that checks box#1 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 information. Insurance Company Name: Berkshire Hathaway GUARD Insurance Policy#or Self-ins. Lic. #:AMWC332951 Expiration Date:O4/2023 Job Site Address: 8 Birch Lane City/State/Zip: Florence, MA 01062 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: *Al Al 5/31/2023 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(check one): 10Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0 Other Contact Person: Phone#: Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ill Cons r _. . ' 1114 CS-106178 cpires ; 09/29/2023 WESLEY COUTURE 139 PACKARDVILLE ROAD PELHAM MA 01002 `� ;ii /\� ' 1 v I' P • J Commissioner .lei f , -- L '":,k_. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration i = .- At .,.w. Type: LLC e tation: 175982 AMERICAN INSTALLATIONS, LLC 1MA f'ration: 06/26/2025 130 COLLEGE STREET _ SUITE 100 SOUTH HADLEY, MA 01075 ,. Si -1 s, s •, ` Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE: LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 175982 06/26/2025 Boston, MA 02118 AMERICAN INSTALLATIONS LLC COUTURE �� 4e--- VVESLEY 130 COLLEGE STREET ., * a./ 7//// A. SUITE 100 ^ SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature AC o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/30/2022 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 policy(ies)must have ADDITIONAL INSURED provisions or 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 Barbara Grynkiewicz NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): 8 North King Street E-MAIL bgrynk{ewicz@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Employers Mutual Casualty Company 21415 INSURED INSURER B: AmGUARD/BH GUARD 43290 American Installations,LLC INSURER C: Attn:Wes&Suzanne Couture INSURER D: 130 College Street,Suite 100 INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 9/4/23 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 ADOL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,DAMAGE I RED 000 X CLAIMS-MADE OCCUR PREM SESO(Ea occccu ence) $ 500,000 X Liquor Liability 10,000 MED EXP(Any one person) $ A 5D3535223 09/04/2022 09/04/2023 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY X JEa LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED 5Z3535223 09/04/2022 09/04/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) PIP-Basic $ 8,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB 5J3535223 09/04/202 09/04/2023 1000000 CLAIMS-MADE AGGREGATE $ , , DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? Y N/A AMWC332951 09/04/202 09/04/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1)11,.-D c J ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD American Installations Home Performance Contractor 130 College Street,South Hadley,MA 01075 CONTRACT - AUDIT American Installations 413-552-0200 FAX 413-552-0202 CUSTOMER PHONE DATE CLIENT# WORK ORDER Elizabeth Sheirer (413) 584-4794 05/23/2023 806485 48901 SERVICE STREET BILLING STREET PROPOSED BY: 8 Birch Lane Lt18 8 Birch Ln American Installations SERVICE CITY,STATE,LP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence,MA 01062 Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL PERFORM AIR SEALING AT ESTIMATED 62.5 CFM50 PER HO 8 $754.64 $754.64 Seal areas of your home against wasteful, excessive air leakage. Materials to be used to 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.) EXTERIOR DOOR WEATHER STRIPPING 3 $95.43 $95.43 Provide labor and materials to install Q-lon weatherstripping to door(s)to restrict air leakage. DOOR SWEEP 3 $78.33 $78.33 Provide labor and materials to install a doorsweep to restrict air leakage. ATTIC FLOOR ENCLOSED CELLULOSE 8" DENSE PACK 256 $724.48 $543.36 $181.12 Provide labor and materials to install an 8"layer of R-25 Class I Cellulose to floored attic space. INSTALL 6"FIBERGLASS BATTING IN OPEN ATTIC FLOOR 200 $434.00 $325.50 $108.50 Provide labor and materials to install a 6"layer of R-19 unfaced fiberglass batts to attic space. HATCH: THERMAL BARRIER POLYISO 2 INCH (ATTIC) 1 $47.37 $35.53 $11.84 Provide labor and materials to insulate the back of an attic hatch with 2"rigid insulation board at R-10. DOOR: THERMAL BARRIER POLYISO 2"(ATTIC) 1 $90.61 $67.96 $22.65 Provide labor and materials to insulate the back of the attic door with 2"rigid insulation board. INSULATE RIM JOIST WITH 2"THERMAL BARRIER POLYISO 20 $97.40 $73.05 $24.35 Provide labor and materials to install rigid board insulation to the perimeter of the basement ceiling at the house sill. INSULATE RIM JOIST WITH 6.25"FIBERGLASS BATTING 75 $201.75 $151.31 $50.44 Provide labor and materials to install R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. American Installations Home Performance Contractor ►1 130 College Street,South Hadley,MA 01075 CONTRACT - AUDIT American Installations 413-552-0200 FAX 413-552-0202 CUSTOMER PHONE DATE CLIENT It WORK ORDER Elizabeth Sheirer (413) 584-4794 05/23/2023 806485 48901 SERVICE STREET BILLING STREET PROPOSED BY: 8 Birch Lane Lt18 8 Birch Ln American Installations SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence,MA 01062 Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL PROPAVENT 2' OR 4' 48 $198.24 $148.68 $49.56 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. Total: $2,722.25 Program Incentive: $2,273.79 Customer Total: $448.46 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Forty-Eight&46/100 Dollars $448.46 $200.00 DPC CC • Nicolas Os COMPANY REPRESENTATIVE CUSTOMER SIGNAT 5/23/23 NOTE:THIS CONTRACT MAY BE IMTHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE 30 DAYS.