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17A-245 (8) 86 LAKE ST BP-2016-1037 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-245 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP-2016-1037 Project# JS-2016-001756 Est. Cost: $9842.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq. ft.): 16988.40 Owner: WANNER JOHN&MIRIAM PARIS Zoning: URB(100)/ Applicant: KEITER BUILDERS AT. 86 LAKE ST Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 () WC FLORENCEMA01062 ISSUED ON:2/23/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department 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. Certificate of Occupancy Sivature: FeeType• Date Paid: Amount: Building 2/23/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only { 1 City of Northampton Status of Permit. Building Department Curb,Cut/Driveway Permit 212 Main Street Sewer/Septic Availability - f3 %Qls i Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Pians ',spho a 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit 86 Lake Street Florence, MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Miriam Paris &John Wanner 86 Lake Street Florence, MA 01062 Name(Print) Current Mailing Address: 267_210_9272 S t �(LtitX C-1 `I� l Telephone Signature 2.2 Authorized Agent: Name( 'nt) Current Mailing 8.8 Address: SAU8C-C) i a re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 9,841.74 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection e77 APO 6. Total= 0 +2+3+4 +5) Check Number -- This Section For Official Use Only Building Permit Number: Date issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L:_ R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YEE O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all age]l cable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors M Accessory Bldg. ❑ Demolition ❑ New Signs rj] Decks Siding❑] Other[p] Brief DKec0PaFS&nTWj1tec�Ows Work: Alteration of existing bedroom Yes X No Adding new bedroom Yes X Attached Narrative Renovating unfinished basement Yes �o _No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing,complete the followlnoL. a. Use of building : One Family Two Family Other window b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, John Wanner as Owner of the subject property hereby authorize Keiter Builders. Inc to act on my behalf, in all matters relative to work authorized by this building permit application. Please see attached signed contract 02 22 16 Signature of Owner Date I, Keiter Builders. Inc 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. Scott Keiter Print Name -a I,--_ 02.22.16 Sign r Agen - Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:Scott Keiter CS-102457 License Number 51 A Hatfield St Northampton, MA 01060 6.20.16 ;Addre4ss4 Expiration Date 413.586.8600 Telephone 9.Registered Home Imurovement Contractor. Not Applicable ❑ Keiter Builders Inc 175168 Comoany Name Registration Number 35 Main Street Florence, MA 01062 4.29.17 Address Expiration Date Telephone 413.586.8600 SECTION 10-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....... 0 No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.35.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature The Commonwealth of Massachusetts Department of Industrial Accidents t Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Keiter Builders, Inc Address:35 Main Street City/State/Zip: Florence, MA 01062 Phone #:413.586.8600 Are you an employer? Check the appropriate box: Type of project(required): 1.10 1 am a employer with 15 4. 0 I am a general contractor and 1 6. ® New construction employees (full and/or part-time).* have hired the sub-contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, ® Demolition workingfor me in an capacity. employees and have workers' y9. � 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 1 am a homeowner doing all work officers have exercised their I I.CJ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.CJ Roof repairs insurance required.] t c. 152, §1(4),and we have no windows employees. [No workers' 13.6 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. tContractors 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:Arbella Policy# or Self-ins. Lic. #:9127440615 Expiration Date:6.11.16 86 Lake St Florence, ma Job Site Address: City/State/Zip: 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 der the pains and penalties of perjury that the information provided above is true and correct. 02.22.16 Signature: fit' ( -XDate: Phone#: 4 .586.8600 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Williamsburg, MA City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: 86Lake St Florence MA 01062 The debris will be transported by: Kelter Builders. Inc The debris will be received by: valley Recycling Building permit number: Name of Permit Applicant Keiter Builders. Inc 02,22.16 zl� Date Signature of Permit Applicant KE(TERBUILDERS, INC. 0WN[Q / 43N, Scott Keiter, President Date Date uoic �rO7ICE: lHESK)NQi}K[SDFT||EP,\KU[S ,\B()V[ /\PPLY0K(} T0TH[ ,\GK[EK1ENT0[ ll|[ P/\KT|E6 |\) /\iTLRN,ATI VI: |)|S!/[T[ S[[[iE\,I TlKlTl/\ D BY lUEC0NTR6O'oK. TD[ OVVN[K MAY |NUl6[[ ,\IAT-KN,\]1V[ U/SPUT[ K[S0i0l0N FIVEy4 VVH[R[ TUlS SECllON IS NOT S[P4K/\TLiT 5lONLU 8Y TU[ PARll[S. [H[ K|GHT TO ALTERNATIVE DJBPUT[ K[0OiOT|0N S|l&ii [NDTWY} YEARS /\F[ERT8E DATE OFT8l8 AGR[[K42NT. N0T7CE: ll|[ S|GN/\TUK[8 0F TH[ P/\Kll[8 /\B()V[ /\PPLY 0NLY TOl'HE AGR[[\1L"MTOF THE P&R[|[S Tl) 4[[EkNAllV[ DISPUTE 9[lTiENFNT /N[D0l�D BY T8[ CONTK/\[TOR. DUEO\VNER MAY |NIll/\T[ D|SPOlI RESOLUTION EVEN VVH[KE THi3 9[CT|0N IS NOT SB\\R/\TB,Y SIGNED BY lli[ PARTIES. [UE RIGHT TO |N[il/\]I AiTEDNJUVE DISPUTE R[SUL[llOKSH/\LL [NDl'YV0Y[/\DS /\Hl]< ll|[ DAT[ O|� ll]l8 /VGK[|:\1[NT. MIS[ELlAAIEOU',�: l'hisagnemen\ is N'lusxuhuscUscoo{ruci contains the coiireu�ruunen( he\ocen us. unv rcporsentkionuor »unaniics not cxyoya|y contained in it are not u part ofdic /\grermcnL and it is binding upon our heirs. CXeco|vn. succcssory and assigns. ]hiu �grcomcm may be modified only by un inmnumcnI. in writing signed h\ butho[us. l.his u�mcmcu( is subject to and is intended to comply with (hc pnmisiooy o/' Chapter 142/\ of the >|uyymchunsiS6encru| Laws and its corresponding regulations. U\�nurUnderstands and acknowledges that KcitcrBui\dco, Inc. muy use an,,. photos taken during the course o[ work- k`r pronx`|ionx) por|xoycx. This may inc|udc, but is not limited /o, the k`Unving: VVch*i1c. nonspopcm, � �o d ]ourou|s. mugazmcs. pos . xn flyers. RIGHTRlC+-VCEL. CN\A7RAC7. YOU KJ/\Y [AN[B, TH|S |F [[ ||/\S 13FEN8lL]N[|) 8Y /\ PARTY TUEKETUBY F(}K\Y&&D|NG YOUR INTENT TO IN \VR[UNG BY ORDINARY MAIL POSTED, BY [H.E0R/\K1 S[KT OR UT DD]V|�KY. NV|' L&llLKllI/\�� MIDNIGHT OF ll|[ THIRD BUSINESS DAY FOLLOWING T||FSK6N|N6OFTH|S /\6K[[h1[NT. � faN signing this AV_reemellt. Vou acknowlcdge that you ha,c receiVed a complete and original signed copy 4the entire Agreement and attached Lxhibits. Kciter Builders. Inc. may not start work until after this agreement has been signed. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. THIS IS A LEGALLY BINDING AGREEME'NT. IF THERE ARE ANY PROVISIONS WHICH YOU DO NOT UNDERSTAND, YOU SHOULD CONSUL T WI TH AN A T"TORNEY BEFORE SIGNING. KEITER BUILDERS, INC. OWNER i ilk,, Scott Keiter, President Date uj Date Date 6 PARIS (02.08.16) February 8, 2016 Scott Keiter , ORKeiter Builders, Inc. � "OPE F r r a 35 Main Street Florence, MA 01062 KESTER Office 413.586.8600 Fax 413.280.0124 BUILDERS scottkeiter@gmail.com www.KeiterBuilders.com License #: 102457 Project Customer PARIS (02.08.16) Emmy Paris & John Wanner Mobile 267-210-9272 86 Lake Street 86 Lake Street miriamsparis@gmail.com Florence, MA 01062 Florence, MA 01062 WINDOWS Description --- Cost Windows See r k Miles quote x CJKI XPX Windows(Installation and Misc.Materials) Mudding Permit Demolition&debris removal -Staging e.Ladders Site set-up&breakdown i 1,New construction unit in-ming R(x�:n (I)New construction unit:n downstairs bathroow, -l I)New construction unit in stairwell Includes fixed lite cnd above filed n7ull I I,New construction unit in front morn Intal 1,11 existing window in,front room Install zip srieathir-y,tape to existing,remove pcnannei.piece lit metal siding(owner to provide siding),air sea:,fiberglass insulation,drywall.tape aria finish,no painting f primer (1;New construction unit i:,,Upstairs Bathroom Modify upstairs bathroom window training to accommodate new,shorter window Field mull fixed transom -All windows will include the roilowing Hough opening prep Flan flashing --Inslallatian of new windows 10 all manufacturer spocificaoons lashing tape at nailing fins F:Xlenor casing and drip Cap to match recently installed umis(Boral Trim and whit?.alurritrium) Low expansion win%-YDw foam insulation -Imenor casirx,;,stool apron installed by others.NIC Painting and i or Staining by others. NIC Project Total $9,841.74 We appreciate your business and look forward to working with you. Approved By: Date 6-,2 . -2 Date:Date: �o�d� Contractor Customer Keiter Builders. Inc, License N ',02457 t