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12C-079 (8) BP-2024-0963 20 MARC CIR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: I2C-079-001 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-2024-0963 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 8600 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date: 09/29/2025 Use Group: Owner: MAUREEN YOUNG, HOLLY Lot Size(sq.ft.) Zoning: RI/WSP Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC32951 SOUTH HADLEY, MA 01075 ISSUED ON: 07/30/2024 TO PERFORM THE FOLLOWING WORK: INSULATION!W EATH ER I ZATI 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. �r Signature: l�/�[ Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner lauki V // C _ 24-LI0029 City of Northampton J�/� �✓/��� DepFOR Building Departne t Jo -7—�� • 212 Main Street:�),���o <70�� / INS ULA TION Room 100 q. , ` = ''( Northampton, MA 0106 T 4G„ys'°F phone 413-587-1240 Fax 413-587- ONL 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 20 Marc Circle Florence, MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Young, Maureen 20 Marc Circle, Florence, MA 01062 Name(Print) Current Mailing Address: 4133208025 See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) ,/ Current Malting 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 8600 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing () Building Permit Fee 4. Mechanical(HVAC) i 476 5. Fire Protection 6. Total = (1 +2 +3 +4+5) 8600 Check Number y 7 ..� a This Section For Official Use Only Building Permit Number: I1J 2-C/r F 6, Date Issued: / Signature: / 7" -Z02=11 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 ! /7 /� Expiration Date l/ (413)552-0200 Signature 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 _ .5 6/26/202 Address v 7.t._ 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 ,CV No 0 NOTE: �l) Brief Description of Proposed Work 1�l O I E INSULATION O ONLY Attic and basement insulation and air sealing throughout. 1, 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 7/16/24 Signature of Owner/Agent Date Young, Maureen , as Owner of the subject property • hereby authorize A tticlictitt Itlstullrrti��1l. to act on my behalf, in all matters relative to work authorized by this building permit application. See attached 7/16/24 Signature of Owner Date City of Northampton Massachusetts ' �._ `e -i DEPARTMENT OF BUILDING INSPECTIONS ' ,�, \s ' ;!' 212 Main Street • Municipal Building '..• �.� Northampton, MI► 01060 6i ;y j‘�, 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: 8600 Address of Work: 20 Marc Circle, Florence, MA 01062 Date of Permit Application: 7/16/24 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: 7/16/24 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 Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building . � Northampton, MA 01060 P� .. `10 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: 20 Marc Circle, Florence, MA 01062 (Please print house number and street name) Is to be disposed of at: K c, W Materials e!Recycling, 138 Palmier Aye, 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) 7/16/24 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 /o o� Massachusetts 4 • ` . P DEPARTMENT OF BUILDING INSPECTIONS 1) 3L^ 212 Main Street • Municipal Building v/, • Ja Northampton, MA 01060 +f • �1 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 20 Marc Circle, Florence, MA 01062 Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413) 552-0200 Property Owner Young, Maureen Name: Address: 20 Marc Circle City, State: Florence, MA 01062 l ll r>l i h. (;outury (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 7/16/24 Homeowner Agreement Mmtreen Voting (Pi npPrti owner)certify that I am the owner/airth(rited agent fee the tremor'', ,• 20 Marc Circle. (numt*r,street name,apt U) Florence, MA 01062 itlty/town) I further certify that I have given my permission to American Installrtiom, LLC to allow work on the property listed above in accordance with the following provisions: Weatherization ® Other(HVAC, Water I(rater, Abatement, Electrical, Roofing, Windows, Sheet Rock.. Plumbing, Carpentry, Pest Control, Air Quality Testing, Waterproofing. and/or whatever else is required to complete weatherization or available to the home through `lass Save Income Eligible) 1.) In the event that efficiency and/or repair measures are completed by the subgrantee and that the property owner decides to sell the aforementioned premises,within one(l)sear from the date of signature on this work permit,the property owner agrees to reimburse the subgrantee an amount equal to the total cost of the materials installed and labor performed in the premises,as documented by the subgrantee,as of the date of sale. Said amount shall be paid to the agency immediately upon sale. 2.) Weatherization and other energy savings measures must be installed following the completion of any major repair work performed on the premises. (i.e. Roof replacement,knob& tube mitigation, vermiculite mitigation,etc.) 3.1 And such other particulars as may be attached to this agreement. � Date: Z 0 ZLf Signature of Owner: 1110111 American Installations WEATHERIZATION PROPOSAL Maureen Young 4/22/2024 (Client Name) (Gate) 20 Marc Circle MA (Address) (City) (State) (Zip) 781-266-8575 maureenyoungfs@amail.com (Primary Phone) (Secondary Phone) (Email) 24-LI0029 (Site ID) (lob a) ITEM QTY UNIT PRICE UNIT TOTAL Attic/basement blower door guided sealing with one-part foam 1 $ 105.00 man/hr $ 105.00 Weatherstrip w/Q-lon or equivalent 2 $ 76.00 ea $ 152.00 Fixed Sweep triple flange 2 $ 27.00 ea $ 54.00 Seal ducts with mastic or butyl backed tape 1 $ 105.00 hr $ 105.00 Continuous variable speed fan w/controls(whole house replace existing) 1 $ 1,090.00 ea $ 1,090.00 Labor per hour 2 $ 104.00 hr $ 208.00 R-18-20 unrestricted-settled cellulose or equivalent 1,040 $ 2.30 sq ft $ 2,392.00 Accu vent or durable equivalent 60 $ 9.78 ea $ 586.80 Weatherstrip(Q-lon or equivalent)&R-code attic hatch side slide-1/2"plywood 1 $ 104.00 ea $ 104.00 Wood clapboard/shakes/shingles or vinyl(dense pack) cellulose or equivalent 1,056 $ 3.52 sq ft $ 3,717.12 Sill/mudsill seal&insulate to R-19(TMAX) 14 $ 3.96 In ft $ 55.44 TOTAL WEATHERIZATION= $ 8,569.36 PROPOSAL NOTES labor hours-storage removal APPROVED By Destiny Jette at 7:07 am, Jul 15, 2024 Signature Date lne c-ummunweuzan of wlussucnuseus Department of Industrial Accidents = 1— Office of Investigations =Zan= .. . Lafayette City Center mimes =ta�= 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): 1.0 I am a employer with 43 4. ❑ I am a general contractor and I 6 El New construction employees (full and/or part-time).* have hired the sub-contractors 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 workingfor me in anycapacity. employees and have workers' p tY 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13.❑� Other comp. insurance required.] *Any 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: 20 Marc Circle 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 ofperjury that the information provided above is true and correct. Signature: Date: 7/16/24 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): 11:1Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: 1 ACORO) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) Illease/ 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. PAHOONEN Est): (413)586-0111 (AJC.No)[ (413)586-6481 Webber&Grinnell Division E-MAIL nrgaiters@webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC M 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 OCCURRENCEDAMAGE T S 1,000,000 CLAIMS-MADE X OCCUR P EM SESO(Ea occurrence) $ 500,000 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 X PRCTO 2,000,000 _ JE LOC PRODUCTS-COMP/OPAGG S 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 s 8,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1.000'000 A ~J EXCESS UAB CLAIMS-MADE AGGREGATE 09/04/2023 09/04/2024 $ 1.000,000 DED X RETENTION S 1D'0D0 $ WORKERS COMPENSATION X STATUTE EOTH AND EMPLOYERS'LIABIUTY Y/N 500,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A AMWC487555 09/04/2023 09/04/2024 E.L.EACH ACCIDENT $ OF EXCLUDED. (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 II 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 I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more specs 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts r 0, Division of Occupational Licensure Board of Building Regulations and Standards Cons 't �rvisor CS- 106178 -. fires: 09/29/2025 WESLEY COUTURE r 139 PACKARDVILLE ROAD PELHAM MA -01002 1i1.1Va 1 ' Commissioner , L., At,AA14I pi._ THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration TAZ. Type: LLC istration: 175982 AMERICAN INSTALLATIONS, LLC 130 COLLEGE STREET L — ' egExpiration: 06/26/2025 SUITE 100 / ' SOUTH HADLEY, MA 01075 +' 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 Re istratlon Expiration 1000 Washington Street -Suite 710 175982 06/26/2025 Boston,MA 02118 MERICAN INSTALLATIONS,LLC IESLEY COUTURE 30 COLLEGE STREET a i% IV" lff- UITE 100 OUTH HADLEY, MA 01075 Undersecretary Not valid without signature