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35-271 (9) BP-2024-1565 165 WEST FARMS RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-271-001 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-2024-1565 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2024 Contractor: License: Est.Cost: 3800 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date:09/29/2025 Use Group: Owner: A OMASTA JOHN P& FAYE Lot Size (sq.ft.) Zoning: WP/WSP Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 WC9127628 SOUTH HADLEY, MA 01075 ISSUED ON: 11/25/2024 TO PERFORM THE FOLLOWING WORK: INSULATION/W EATH E R I ZAT I 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: 72. Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 24-1500 DepF04rr ., City of Northampton .• r� Building Department ni, 7-7 ,4, 212 Main Street 1V 2 2 2024 INS ULA TION Room 100 , _ ' Northampton, MA 01060 phone 413-587-1240 -Fax 413-587-1272 ONLY 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 165 West Farms Road Florence, MA 01062 Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Omasta, Faye & John 165 West Farms Road Florence, MA 01062 Name(Pent) Current Mailing Address: (978) 852-4186 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 3,800 (a) Building Permit Fee 2. Eectrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing () Building Permit Fee 4. Mechanical(HVAC) 0 5. Fire Protection 6. Total =(1 +2+3 +4+5) 3,800 Check Number 64/ Q ) This Section For Official Use Only f/ Building Permit Number: big 17 r/605 Date Issued: Signature: / - //- 2-Z5/ 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 ❑ Name of License Holder: Wesley K. Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 9/29/2025 Address /I) A. M____ 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 6/26/20 25 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 .CEj No 0 Brief Description of Proposed Work NOTE:O TE: INSULATION ONL Y Attic and basement insulation and air sealing throughout. 1, American Installations- Wesley Couture , ao 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/ /7 A. .L. 11/14/2024 Signature of Owner/Agent Date I, Omasta, Faye & John , 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 11/14/2024 Signature of Owner Date City of Northampton j A Massachusetts ��T• .- c,. t I, G ; "l (t "- DEPARTMENT OF BUILDING INSPECTIONS �' m \ '' y 212 Main Street • Municipal Building vy'Pi"... , a fib.yj.yc� Northampton, MA 01060 sIl**iiON. 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: 3,800.00 Address of Work: 165 West Farms Road Florence, MA 01062 Date of Permit Application: 11/14/2024 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: 11/14/2024 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 �w � City of Northampton Massachusetts �? �. 't�G rr i�'..A 1:,! �n s iE tt,{ rz DEPARTMENT OF BUILDING INSPECTIONS �`., Z, ���':+► ' 212 Main Street *Municipal Building Northampton, MA 01060 rrYj\�J 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: 165 West Farms Road (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) G // 11/14/2024 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. � City of Northampton _ Massachusetts a`' << t te `s.. DEPARTMENT OF BUILDING INSPECTIONS Si 212 Main Street • Municipal Building 0 4.` 1`�CD _ Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address. 165 West Farms Road 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: Omasta, Faye & John Address: 165 West Farms Road 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 11/14/2024 raye i us ilOrfart- • mass save Licensed&insured MA CSL a:106118 PARTNER MA Regtstrotion a 1r5982 American Installations www.Americanlnstallations.com 130 College Street Suite 100,South Hadley,MA 01075• Office:(413)552.0200 Fax:(413)552-0202• Email supportgaAmericanInstallations.com Customer Name:John Omasta Email:Not provided Phone:978-852-4186 Premise Address: 165 W Farms Rd,Northampton,MA 01062 Mailing Address: 165 W Farms Rd,Northampton,MA 01062 Project ID:5355833 Date:Aug.6,2024 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 8 hr $852.72 $0.00 Attic Floor- 12" Dense Pack Cellulose Living Space 192 SF $762.24 $190.56 Attic Floor- 5"Open Blow Cellulose Living Space 672 SF $1,256.64 $314.16 Bath Fan Hose Living Space 2 each $64.46 $16.11 Attic Stair Cover(with AS hrs) Living Space 1 each $313.63 $0.00 Damming Living Space 60 each $166.80 $41.70 Door Sweep(with AS hrs) Living Space 3 each $88.98 $0.00 Exterior Door Weather Stripping (with AS hrs) Living Space 3 each $108.96 $0.00 Rim Joist- 2"Thermal Barrier Polyiso Living Space 20 SF $110.40 $27.60 WARRANTY:American installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regtiationns for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE-S satisfactory and are hereby accepted.You are authorized to do work as specified.Payment will be 1/3 down prior to start of work,and balance due Down Payment= _ ❑ upon Completion. PAID Balance Due Upon Completion- S Signature Date Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date THIS AAmmon i5(DWPOSEO Or TMRPAGE AMO THE*MASI SCE CO T105 PAW AMC SMALL BE caxSCE1e0 THE MIME AGAECMEM F THEPARTOS MOWED THIS AIOEEMVIT ti BETWEEN AATCAKAM 101S7A4U110MS,LLC Ma4MYTEx AURE°10 AS t0ve10n', AMOTME CUSTOMEAIS)rtww MOVE,MECOrAfTEx RVEINED TO AS'sear.AM)WASPS SUBJECT TONS AKROPRMTE LAWS,REeUSATKMS AMO OAOMANQS Of nit STATE Or MASSACHUSETTS 00 COMMA/IT R6PECTM[LT,Af WELL AS ALL LOCAL 1UIMO MOMS rtayr 6 la1 mass save jcensed& nslued PARTNER MA CSI..106178 , A MARegetmtlonp I 759R7 American Installations tivww.Americanlnstallations.com 130 College Street Suite 100,South Hadley,MA 01075• Office:(413)552.0200 rax:(413)552.0202 • Email supporlipAmericanlnstallations.com Customer Name:John Omasta Email:Not provided Phone:978-852-4186 Premise Address: 165 W Farms Rd,Northampton, MA 01062 Mailing Address: 165 W Farms Rd.Northampton.MA 01062 Project ID:5355833 Date:Aug.6.2024 Project Total $3,724.83 Weatherization incentive ($1,770.41) Air sealing incentive ($1.364.29) Total Program Incentive -$3,134.70 Customer Total $590.13 WARRAN'Y:American rntallatiOns._C will provide the above stated homeowner with a 1.year worknunship warranty. American:nstalatorn.LLC hereby proposes to furnish all material and labor to complete the above scope or work in accordance with the above specifications and all kcal and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE'- S 590.13 satisfactory and are hereby accepted.You are authorized to do work as specified.Payment own Payment work, nc - s100.00 ey' C.C. will be 1/1 down prior to start of and balae due upon Completion. LLJ PAID Balance Our Jpcn Completion- s490.13 Signature Date Property Owner(Print) Faye Omasta (Sign) Date 8/7/2024 Representative:(Print; Nicolas Os (sign) 45� 04- Date 8/7/2024 TeI1 AGREtMEN I IS COMPOSED Of INIS PAGE AND'NE REVERSE SIDE OF Ten Past AND SHALL BE CONSIDERED nit MIRE AGREEMENT m THE PART lS INVOLVED'MIS AGREEMEN'i5 ail W EtE1 iMERICAR INSTAEIA1NONS.LLC NOLEINwTOE REFOtrEO TO AS"COMPANY, ANO'Ht W SIOMERIS)NAMED ABOVE,HEREIN uI ER REFERRED TO AS"CLIENT'.AND VOLE OE SUIDECT WALL APPROPRIATE LAWS,REGULAIIONS AND ORDINANCES OF THE S7alE of MASSAENUSRIS OR CONNECIICUI RESPECT iVEir.AS WELL AS ALL LOCAL,DRISo clioNS one uummunweuun of inussucnuseus Department of Industrial Accidents =4 Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 "''N� •'� 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.❑■ I am a employer with 52 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. ❑ 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.t 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 11.0 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 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: 165 West Farms Road 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 nder the pains and enalties of perjury that the information provided above is true and correct Signature: Date: 11/14/2024 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): 11:1Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: ACORO CERTIFICATE OF LIABILITY INSURANCE GATE(MM/DD/YYYY) 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 Dowd Agencies, LLC PHONE Linda Alstede 14 Bobala Rd WC.No.Ert F y 413-538-7444 I FAX,No):413-536-6020 Holyoke MA 01040 EA DRESS: Ialstede@dowd.com INSURERS)AFFORDING COVERAGE NAIC I L icense#:BR-1201657 INSURER A:Selective Insurance Co.of America 12572 INSURED AMERINS-01 INSURER e:Selective Insurance of South Carolina 19259 American Installations, LLC 130 College Street, Suite 100 INSURERC: South Hadley MA 01075 INSURER o 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 PAID CLAIMS. NNW TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP UNITS LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDO/YYYY) A X COMMERCIAL GENERAL LIABILITY S 2641028 9/4/2024 9/4/2025 EACH OCCURRENCE $1,000,000 DAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 MED EXP(My one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEM.AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE $2,000.000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S B AUTOMOBLE LIABILITY A 9110607 9/4/2024 9/4/2025 COMBIaNdentlED SINGLE LIMIT $1,000,000 (Ea ac _ X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS x HIRED y NON-OWNED PROPERTY DAMAGE S _ AUTOS ONLY AUTOS ONLY (Per accident) $ A X UMBRELLA UAB X OCCUR S 2641028 9/4/2024 9/4/2025 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTIONS n $ B WORKERS COMPENSATION WC 9127628 9/4/2024 9/4/2025 X AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 11 yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 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 ACCORDANCE WITH THE POLICY PROVISIONS. For Insurance Purposes Only United States AUTHORIZED REPRESENTATIVE ©1 988-201 5 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards ConstkVcti n, fir S► ervisor 117 ! CS- 106178 �ires 09/29/2025 WESLEY COUTURE • r 139 PACKARDVILLE ROAD PELHAM MA V1002 I :: ' Commissioner L A THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration si )ri .......,..., i. f'"� —�— r Type: LLC AMERICAN INSTALLATIONS, LLC I,., �x — Registration: 175982 130 COLLEGE STREET air. _ Expiration: 06/26/2025 SUITE 100 ,~�� ��'�'� `� -�~ -1 � SOUTH HADLEY. MA 01075 .\'i, '. 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 06126/2025 Boston. MA 02118 MERICAN INSTALLATIONS. LW /ESLEY COUTURE / 30 COLLEGE STREET `. ,,,-*°'. ,/ / UITE 100 OUTH HADLEY. MA 01075 Undersecretary Not valid without signature