16D-005 BP-2024-0356
194 NORTH MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
16D-005-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2024-0356 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2024 Contractor: License:
Est. Cost: 3500 AMERICAN INSTALLATIONS LLC 106178
Const.Class: Exp.Date: 09/29/2025
Use Group: Owner: T MEW MICHAEL S&MARIE
Lot Size (sq.ft.)
Zoning: URB Applicant: AMERICAN INSTALLATIONS LLC
Applicant Address Phone: Insurance:
130 COLLEGE ST SUITE 100 (413)552-0200 AMWC32951
SOUTH HADLEY, MA 01075
ISSUED ON: 04/01/2024
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATHERIZATION
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 NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
/e72-
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
24-0483
' LJUILT 1q)O
p a ;0,;3i
a ,.� City of Northampton As4h Dep to 4k `
� r Building Department .
INSULA 1T14N
il , _...A 4,. ,
212 Main Street t
:! Ott Y" 41' Room 100
.W : Northampton, MA 01060 vi, w_phone 413-587-1240 Fax 413-587-1272 x t,fgY oNL 1 ,
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
194 North Main Street
Florence, MA 01062 Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Mew, Michael & Marie 194 North Main Street, Florence, MA 01062
Name(Print) Current Mailing Address: 4135844994
See attached Telephone
Signature
2.2 Authorized Agent:
American Installations 130 College Street Ste. 100, South Hadley, MA 01075
Name(Print) Current Mailing Address:
�/ it (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 3500 (a) Building Permit Fee
2. Electrical 0 (b) Estimated Total Cost of
Construction from (6)
3. Plumbing 0 Building Permit Fee
4. Mechanical(HVAC) 0 '31,6,
5. Fire Protection '
6. Total=(1 +2+3+4+5) 3500 Check Number Y/ 3 50
This Section For Official Use Only
, Al Date
Building Permit Number: 6�017(fr (f Issued:
Signature: // J-Zq zoZq
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 9/29/2025
Address�,' , M2_ Expiration Date
(413) 552-0200
4Wia Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
American Installations 175982
Company Name Registration Number
130 College Street Ste. 100, South Hadley MA 01075 6/26/2025
Address j..._ M_____ 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 jil 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
3/19/24
Signatuns of Date
I, dIIIIIIIIIIIIIIIIIIIIIIIINIM , as Oggier 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 3/19/24
Signature of Owner Date
City of Northampton
�/ � ` � Massachusetts .- ,•e•
1t. ,I �:
I w DEPARTMENT OF BUILDING INSPECTIONS �'•.
212 Main Street • Municipal Building 6 S.
Northampton, MA 01060 r `10
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: 3500
Address of Work: 194 North Main Street, Florence, MA 01062
Date of Permit Application: 3/19/24
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:
3/19/24 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
/ � u+ ; .
.o -_ •
, Massachusetts w{ - {
etit
(41
DEPARTMENT OF BUILDING INSPECTIONS
' 's atiF 212 Main Street •Municipal Building Jd OP-
w .,. ,�,,E•� Northampton, MA 01060 5''
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:
194 North Main Street, Florence, MA 01062
(Please print house number and street name)
Is to be disposed of at:
K er 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)
74/1/ 3/19/24
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
,�•?i x '�� `�''= �'c�F
Massachusetts ��.CAS" ;G
v
• ; DEPARTMENT OF BUILDING INSPECTIONS ti`•. 1"
\!! 212 Main Street • Municipal Building
P°i; Northampton, MA 01060 S�NI �YJ�1
MANDATORY FOR HOUSES BUILT BEFORE 1945
Property Address: 194 North Main Street, 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: Mew, Michael & Marie
Address: 194 North Main Street
City, State: Florence, MA 01062
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 3/19/24
American Installations
EVERSURCE Home Performance Contractor
130 College Street,South Hadley,MA 01075 CONTRACT - AUDIT
413-552-0200 FAX 413-552-0202
CUSTOMER PHONE DATE CLIENT# WORK ORDER
Michael Mew (413)584-4994 03/05/2024 817239 48901
SERVICE STREET BILLING STREET PROPOSED BY:
194 N Main Street 194 N Main St American Installations
SERVICE CITY,STATE,ZIP 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 2 $213.18 $213.18
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 $108.96 $108.96
Provide labor and materials to install Q-Ion weatherstripping to
door(s)to restrict air leakage.
DOOR SWEEP 3 $88.98 $88.98
Provide labor and materials to install a doorsweep to restrict air
leakage.
ATTIC FLOOR ENCLOSED CELLULOSE 7" DENSE PACK 868 $2,612.68 $1,959.51 $653.17
Provide labor and materials to install a 7"layer of R-22 Class I
Cellulose to floored attic space.
INSULATION REMOVAL 50 $70.50 $0.00 $70.50
Batt style insulation will be removed from the attic area and properly
disposed,off site.
DOOR:THERMAL BARRIER POLYISO 2"(ATTIC) 1 $103.05 $77.29 $25.76
Provide labor and materials to insulate the back of the attic door with
2"rigid insulation board.
SHEATHING ACCESS FOR AIR SEALING ONLY 2 $92.48 $69.36 $23.12
Provide labor and materials to make an access opening from one
attic area to another by cutting a passage through sheathing. This
access will be left open as it is between two common unheated non
firewalled attic areas.
INSULATE RIM JOIST WITH 6.25"FIBERGLASS BATTING 55 $167.75 $125.81 $41.94
Provide labor and materials to install R-19 unfaced fiberglass
insulation to the perimeter of the basement ceiling at the house sill.
American Installations
EVERS-.--URCE Home Performance Contractor
130 College Street,South Hadley,MA 01075 CONTRACT - AUDIT
413-552-0200 FAX 413-552-0202
CUSTOMER PHONE DATE CLIENT# WORK ORDER
Michael Mew (413) 584-4994 03/05/2024 817239 48901
SERVICE STREET BILLING STREET PROPOSED BY:
194 N Main Street 194 N Main St American Installations
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP
Florence, MA 01062 Florence, MA 01062 Page 2
DESCRIPTION QTY COST INCENTIVE TOTAL
REPLACE BATH FAN HOSE 1 $32.23 $24.17 $8.06
Provide labor and materials to install an insulated 4"exhaust hose to
existing bathroom fan(s).
Total: $3,489.81
Program Incentive: $2,667.26
Deposit: $200.00
Final Total: $622.55
WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***Eight Hundred Twenty-Two& 55/100 Dollars $822.55
$200.00 Collected Check
42
COMPANY REPRESENTATIVE C TOMER SIGNATURE
NOTE THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE 3/5/2024
SIGN DATE
30 DAYS.
A JiG l.vmustfurvieussrs of 1VIUJJUL 1“4.1GLLJ
=T1 Department of Industrial Accidents
Office of Investigations
pm— Lafayette City Center
- ��
2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):American Installations LLC
Address:130 College St, Suite 100
City/State/Zip:South Hadley, MA 01075 Phone#:413-552-0200
Are you an employer?Check the appropriate box: Type of project(required):
1.El I am a employer with 43 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. El New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no Insulation
employees. [No workers' 13.®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.#:AMWC487555 Expiration Date: 9/04/2024
Job Site Address: 194 North Main Street 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.
Si ature: Date:
3/19/24
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 50Plumbing
Inspector 6.0Other
Contact Person: Phone#:
DATE(MWDD/YYYY)
AC o® CERTIFICATE OF LIABILITY INSURANCE
11/20/2023
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 Robert Walters III
NAME:
Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481
(All},No.Ext): (A/C,No):
Webber&Grinnell Division E-MDAliess: rwalters@webberandgrinneli.com
8 North King Street INSURER(S)AFFORDING COVERAGE NAIL N
Northampton MA 01060 INSURER A: Employers Mutual Casualty Company 21415
INSURED INSURER B: AmGUARD/BH GUARD 43290
American Installations,LLC INSURER C: XS Brokers Insurance Agency
Alpine Heat Pumps INSURER D:
130 College Street,Suite 100 INSURER E:
South Hadley MA 01075 INSURER F:
COVERAGES CERTIFICATE NUMBER: Exp 09/04/2024 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 INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE 10 REN I tU 500,000
CLAIMS-MADE /- OCCUR PREMISES(Ea occurrence) $
X Liquor Liability MED EXP(Any one person) $ 10,000
A 5D3535224 09/04/2023 09/04/2024 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000
X POLICY XI PRO- 2.000,000
JECT LOC PRODUCTS-COMP/OPAGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
_ (Ea accident)
ANY AUTO BODILY INJURY(Per person) $
A - OWNED X SCHEDULED 5Z3535224 09/04/2023 09/04/2024 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
X AUTOS ONLY X AUTOS ONLY (Per accident)
PIP-Basic $ 8,000
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000.000
A - EXCESS LIAB CLAIMS-MADE 5J3535224 09/04/2023 09/04/2024 AGGREGATE $ 1.000,000
DED XI RETENTION$ 10,000 $
WORKERS COMPENSATION -s/I PER OTH-
AND EMPLOYERS'LIABILITY /�I STATUTE ER
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000
B OFFICER/MEMBER EXCLUDED? N N/A AMWC487555 09/04/2023 09/04/2024
(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 $
Pollution Liability
C G74352546002 11/10/2023 11/10/2024 Occurrence Limit $1,000,000
Aggregate Limit $2,000,000
DESCRIPTION OF OPERATIONS I 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
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
lip
I
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
r 17 Commonwealth of Massachusetts
Division of Occupational Licensure
Board of Building Regulations and Standards
Constoistebn SUCrervisor
CS- 106178 .. ires: 09/29/2025
WESLEY COVTURE
139 PACKARDVILLE ROAD
PELHAM MA -01002 de
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—,
Ade lilli
Commissioner --
J
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: LLC
AMERICAN INSTALLATIONS, LLC z i'4grstran: 175982
130 COLLEGE STREET '` Expiration: 06/26/2025
SUITE 100
SOUTH HADLEY, MA 01075
Ia
.,:....�" 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
MERICAN INSTALLATIONS,LLC
(ESLEY COUTURE
30 COLLEGE STREET i;(4 ,°14 . ,,�4"'4. i !I
UITE 100
OUTH HADLEY,MA 01075 Undersecretary Not valid without signature