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17A-115 (6)
BP-2024-1118 14 CLAIRE AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-115-001 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-2024-1118 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est.Cost: 2700 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date:09/29/2025 Use Group: Owner: JAMES ROBERTS Lot Size (sq.ft.) Zoning: RI/URA Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC32951 SOUTH HADLEY, MA 01075 ISSUED ON: 08/30/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATI 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. Signature: 17.2_ Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 24-1511 De its City of Norte amp n `f FOR ,�y�° Building Departrrtent4UG 9 212 Roomin ©tr�et 2 /'r'SULA TI CAN v Northampton, MA rE phone 413-587-1240 Fax'44A5$7="lJ i ONL Y 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 14 Claire Avenue Zone Overlay District Florence, MA 01062 Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Roberts, James 142 Hutchins Rd Carlisle MA 01741 Name(Print) Current Mailing Address: (206) 390-9043 See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: /Ili A (413) 552-0 2oo Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2,700 (a) Building Permit Fee 2. Electrical I J (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) 2,700 Check Number g)11,6 This Section For Official Use Only /J Building Permit Number: �" r}'V'1 if 7 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date pertnits@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 9/29/2025 Address it / t _! Expiration Date/ (, (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 6/26/2025 Address i 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 A No 0 Brief Description of Proposed Work NOTE: INSULATION ION ONLY A ttic 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 As t______ 8/16/2024 Signature of Owner/Agent Date I, Roberts, James , as Owner of the subject property hereby authorize AniC1"tt:aii Installiatiori to act on my behalf, in all matters relative to work authorized by this building permit application. See attached 8/16/2024 Signature of Owner Date City of Northampton �trtM y� SAS."' Massachusetts• `. tL DEPARTMENT OF BUILDING INSPECTIONS , IT tf, r $ 212 Main Street • Municipal Building b.•, �. Northampton, MA 01060 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: 2,700 Address of Work: 14 Claire Avenue Florence. MA 01062 Date of Permit Application: 8/16/2024 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: 8/16/2024 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` "otcMassachusetts • DEPARTMENT OF BUILDING INSPECTIONS y, 212 Main Street •Municipal Building Q% Northampton, MA 01060 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: 14 Claire Avenue (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) V/A- M.- 8/16/2024 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. n�; City of Northampton f b''f Massachusetts * - .lit �`G ..1" . ;:-/ DEPARTMENT OF BUILDING INSPECTIONS 5.`• 'I i 4 �a `�_, 1 ;° 212 Main Street • Municipal Building Jiff..,. ,pc ;�,:rr Northampton, MA 01060 Yh' )" MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 14 Claire Avenue 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: Roberts, James Address: 14 Claire Avenue City, State: FlnrenrP MA f 1 fA2 I, iVesley K. Coutur. (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. i Contractor signature ;�7 Date 8/16/2024 American Installations !at.. 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 James Roberts (206) 390-9043 08/05/2024 822377 48901 SERVICE STREET BILLING STREET PROPOSED BY: 14 Claire Avenue 14 Claire Ave American Installations SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Florence, MA 01062 Florence, MA 01062 Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL INSULATE WOOD SHINGLE SIDED WALL 4"DENSE PACK 944 S2,643.20 $2,643.20 Furnish and install blown in Class I Cellulose to Wood shingle exterior walls. The butt of the upper course of your wood siding is cut to drill holes into the wall sheathing behind.The holes are then plugged and the wood siding is reinstalled using exterior grade nails. Touch-up painting, if needed,will be the customer's responsibility. Homeowner has received a copy of the EPA's Renovate Right Lead- Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed.Your signature is your acknowledgement of receipt and agreement to proceed. Total: $2,643.20 Program Incentive: $2,643.20 Deposit: $0.00 Final Total: $0.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***00/ Dollars $0.00 COMPANY REPRESENTATIVE CUSTOMER SIGNATURE NOTE THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE 8,5,24 SIGN DATE 30 DAYS. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards : rviisor CS-106178 fzG E t►psres: 09/29/2023 WESLEY COUTURE • A .t` 139 PACKARDV#LLE • nau;: PE+LHAM MA 01002 Y .-, CST^S r r Commissioner r;:= r "c. m 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: 06/26/2023 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 - _ Update Address and Raturn C i. Office of Consumer Allah*it Business Regulation NOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:LLC before the expiration date. 11 found return to: 8211111BIBIOn Expiration Office of Consumer Affairs and Business Regulation 175982 06/28/2023 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 02118 i '//1/// WE.SLEY COUTURE • 130 COLLEGE STREET surrE 100 ,f✓ '4 i.64.•4 ISO!valid without Signature SOUTH HADLEY,AAA 01075 Undersecretary The Commonwealth of Massachusetts Department of Industrial Accidents Office 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): 1.0 I am a employer with 43 4. 0 I am a general contractor and 1 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. ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. CI Building addition [No workers' comp. insurance comp. insurance.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.❑� Other Insulation employees. [No workers' comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 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:_ ' 1 "' CA tt (C. 40(_ City/State/Zip: p ev7 ,M1a CtO( 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: 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 (check one): 10 Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5Ek'lumbing Inspector 6.0Other Contact Person: Phone#: