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31B-147-002 BP-2024-1515 131 STATE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-147-002 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-2024-1515 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est. Cost: 3000 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date: 09/29/2025 Use Group: Owner: GRONIM JUDITH A Lot Size (sq.ft.) Zoning: URC Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 WC9127628 SOUTH HADLEY, MA 01075 ISSUED ON: 11/13/2024 TO PERFORM THE FOL L O WING 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: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: E:7-"Z_ Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner IA ( L. CCc°`r. It i . 24-1810 .a ,, City of Northampton Dep��R _,_ ` ", Building Department ';. h. 21 Room Otr et INSULATION .41t,,., '.: "7 li" Northampton, MA 01060 ' + phone 413-587-1240 Fax 413-587-1272 QJ1JL_ 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 131 State Street, Unit B Northampton, MA 01060 - 2243 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 131 State Street, Unit B Gronim, Judith Northampton, MA 01060 - 2243 Name(Print) Current Mailing Address: 4135636350 See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: I/, t t (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 3000 (a)Building Permit Fee 2. Electrical () (b) Estimated Total Cost of Construction from(6) 3. Plumbing O Building Permit Fee 4. Mechanical(HVAC) i 076 5. Fire Protection 6. Total =(1 + 2 +3+4+ 5) 3000 Check Number 536-3 This Section For Official Use Only Building Permit Number: 2/ 'd 7' /5)6 Date Issued: Signature: k /i f_S' .!y 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 Colle e Street Ste. 100, South Hadley MA 01075 9/29/2025 Address A 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 viExpiration 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 NOTE:!T Brief Description of Proposed Work 19 E: INSULATION ONL Y 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 10/31/24 Signature of Owner/Agent Date 1, Gronim, Judith , as Owner of the subject property • hereby authorize .1>Hc rictin Instrillutic�ii to act on my behalf,in all matters relative to work authorized by this building permit application. See attached 10/31/24 Signature of Owner Date City of Northampton E•�= Massachusetts • 'e * •G "t DEPARTMENT OF BUILDING INSPECTIONS ?'•• • '17 000 212 Main Street •nMu 01060 nicipal Building v�;•.,,b 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: 3000 Address of Work: 131 State Street, Unit B, Northampton, MA 01060 - 2243 Date of Permit Application: 10/31/24 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: 10/31/24 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 /•rOsµ,'�MPI :' SAS-,J:...SAC•.. Massachusetts At/ t; * c • 0 S DEPARTMENT OF BUILDING INSPECTIONS• ` 212 Main Street •Municipal Building Northampton, MA 01060 r,N O 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: 131 State Street, Unit B (Please print house number and street name) Is to be disposed of at: K er W Materials &Recycling, 138 Palmer 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) I/A 4f10/31/24 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. rH� City of Northampton ,..:••~:.,SC... Massachusetts 'mow F.r * rc. " DEPARTMENT OF BUILDING INSPECTIONS {�;�: �!i 212 Main Street • Municipal Building Northampton, MA 01060 gbh' .' MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 131 State Street, Unit B, Northampton, MA 01060 - 2243 Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413) 552-0200 Property Owner Name: Gronim, Judith Address: 131 State Street, Unit B, Back City, State: Northampton, MA 01060 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 G(/ Date 10/31/24 American installations Customer mane:.na701 Swam roman'vvn5C.legineltem MA Mere:(a13)587.3793 Instaaatwn Aeldneric 131 Stale Street Unit 8 N aludeb1 A6A0t060 Horne Address:MA FM m NulnAer oda,IIa00 Dale:1003102a Job Description ccrtm re paean ar area to be perareud ell tltaraV fart ea Mein Meknes-n a pnMss.ur manner and In auererKe rim One lent delve Came erwuOng ale awoke realm M0elleaVrVt ta1adOnaeg Helper eetelearrieil1l Me taA w00rpeNe anal di a'lt/CKe Cant N Strang at8 9n01ed62.51?N50 Par Nov 1 Hi SIN 50 $000 Was-Gephoerd-an Dane Peck CMttosa e8 son S1 d1 12 $35 28 Wale-Clapboard-em Dense Peck Ce0rbsn 2/2 SOFT 8799 88 $199 92 Walls-Clapboard em Dense Peck CeMloae 252 SOFT 174088 $18522 Wan•Cw{Astvd-Ain Dermal NO;Ce0*r.n 252 SOFI S/4088 S18522 Overhang•10in Dense Pack Cellulose 40 SOFT S215.20 S53.80 Dow Sweep :1 EA 18898 So00 Entire%Door Weather Stripping 3 EA 1108 90 $0 00 Total:$29e2.29 Program Incentive:02282 86 WeatnerllaDon Barrier Incentive:$0.00 Customer Total-1869.ee �C_ Oct 7,2024 k� Ann Gillard �a Customer Signature: Clete: Customer Printed Name: it/�ce 10/6/2024 Nicolas Os Representative Signature: Date: Representative Printed Name: 1ne e,ummonweuun ud.iviussucnuseccs Department of Industrial Accidents _... . ..._@ Office of Investigations ` , Lafayette City Center Y Z 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 Street, 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.II I am a employer with 52 4. ❑ I am a general contractor and I 6. ❑ 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 working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. 0 We are a corporation and its 10.❑ 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.❑ Roof repairs insurance required.] t c. 152,§1(4),and we have no 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: Selective Insurance Co. of South Carolina Policy#or Self-ins. Lic. #:WC 9127628 Expiration Date:09/04/2025 Job Site Address: 131 State Street, Unit B, Back City/State/Zip: Northampton, MA 01060 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 nder the pains and penalties of perjuty that the information provided above is true and correct. Signature: Date: 10/31/24 Phone#: 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): IpBoard of Health 2U Building Department 3.[Iity/Town Clerk 4. ❑Electrical Inspector 5.alumbing Inspector 6.0Other Contact Person: Phone#: AC:C)RE) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY) 9/3/2024 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 Linda Alstede NAME: Dowd Agencies,LLC PRONE 413-538-7444 FA" 413-536-6020 14 Bobala Rd {A/C,No,Ext): (A/C,No) lalstede@dowd.com ADDRESS: MA 01040 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL 0 License#:BR-1201657 INSURER A:Selective Insurance Co.of America 12572 INSURED AMERINS-01 INSURER B:Selective Insurance of South Carolina 19259 American Installations, LLC 130 College Street,Suite 100 INSURER C` - South Hadley MA 01075 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:1429278879 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 PPppAIIDLD��rCLLAIIMS. LTR TYPE OF INSURANCE NASD WSW POLICY NUMBER (MX) (MMIDD/YWY) LIMITS A X COMMERCIAL GENERAL UABIUTY S 2641028 9/4/2024 9/4/2025 EACH ppOECCCURgREENNCCEp S 1,000,000 CLAIMS-MADE i X I OCCUR ME? aacurence) S 500,000 MED EXP(My one person) $15,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE UMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY .ECaT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ l; AUTOMOBILE LIABILITY A 9110607 9/4/2024 9/4/2025 (Ea aBIN aWent)INGLE LIMIT t 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY GE X AUTOS ONLY X AUTOS ONLY (Per accident_ S S A X UMBRELLA UAB X OCCUR S 2641028 9/4/2024 9/4/2025 EACH OCCURRENCE S 1,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE S 1,000,000 DED X RETENTIONS 0 S b WORKERS COMPENSATION WC 9127628 9/4/2024 9/4/2025 X DAME ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE Y E.L EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 8500,000 11 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Insurance Purposes Only United States AUTHORIZED REPRESENTATIVE 9.614 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commo al h of Massachusetts 01 v1 s1 on of Occupational Licensure Board o B tiding Regulations and S n r t11 inns �rvisar N. CS-106178 8ylres : 09/29/2025 WESLEY coyruRE 139 PACKARDVILLE ROAD PELHAM MA 1 > 1002 6114 6 .1 Commissioner 41 r� „�!� THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, M ssachusetts 02118 Home Improvement Contractor Registration 1 Type: LLC AMERICAN INSTALLATIONS LLC 17 !Registration 175982 130 COLLEGE STREET Expiration 06/26/2025 SUITE 100 SOUTH HADLEY,MA 01075 yam.\ f — 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 ftulAtraticii Fxoiratiort 1000 Washington Street -Suite 710 175982 06/26/2025 Boston,MA 02118 AMERICAN INSTALLATIONS,LLC NESLEY COUTURE 130 COLLEGE STREET — — (V/ A "SUITE 100 SOUTH HADLEY,MA 01075 Undersecretary Vot valid without signature