30C-009 KErrElt
BUILDERS 51B Hatfield Street •Northampton•MA•01060•Phone: 413- 320- 9035•Fax: 413 - 586- 1890•keiterbuilders.com
SCOPE OF WORK
JUNE 8, 2010
CUSTOMER NAME: Anne Walko
ADDRESS: 443 Florence Road
Florence, MA 01062
PROPOSAL INCLUDES:
• Building Permit
• Remove all stone from area being covered by deck.
• Remove and dispose of "temporary steps ".
• Remove and dispose of part of the concrete steps.
• Installation of concrete forms.
• Framing and associated hardware.
• Installation of Trex composite decking system. Hidden Fastners.
• Installation of Trex railing system.
• Construct (1) stairway leading to backyard.
• Install fascia and pvc lattice.
Note: This scope is for labor only. All material will be purchased by customer. Any additional material
needed during construction will be purchased by Keiter Builders and added to final bill.
Waste
• A sincere effort will be made by all Keiter Builders employees /sub contractors to minimize waste during the construction project
• Any recyclable material will be separated from general waste
• All waste will be contained in a dumpster and/or taken from site in a timely manner
• The jobsite will be kept clean and tidy at all times during the project
Warranty
• Please see the attached document "Contractors Warranty"
Permits and Inspections
• All applicable permits will be handled by Keiter Builders
• All building inspections will be scheduled by Keiter Builders
TOTAL PRICE FOR ALL LABOR / MATERIAL: $5,200
•
CONTRACTOR'S LIMITED WARRANTY
KEITER BUILDERS
51B Hatfield St.
Northampton, MA 01060
Phone: 413- 320 -9035
Fax: 413 -586 -1890
The contractor signatory below Scott Keiter ( "Contractor ") hereby guarantees
( "Owner ") that the construction performed on that certain structure located at
to be free from defects in material and workmanship for a period of
one (1) year from the date of commencement of use, substantial completion or date of notice of
completion, whichever is the first to occur:
This Standard Limited Warranty applies and is limited as follows:
1. To the property only as long as it remains in the possession of the original owner named
above.
2. To the construction work that has not been subject to accident, misuse or abuse.
3. To the construction work that has not been modified, altered, defaced, or had repairs
made or attempted by others.
4. That Contractor be immediately notified in writing within ten (10) days of first
knowledge of defect by owner or his agent.
5. That Contractor shall be given first opportunity to make any repairs, replacements or
corrections to the defective construction at no cost to owner within a reasonable period of
time.
6. Under no circumstances shall Contractor be liable by virtue of this warranty or otherwise
for damage to any person or property whatsoever for any special, indirect, secondary or
consequential damages of any nature however arising out of the use or inability to use
because of the construction defect.
Signature Date
KEITER : 1 LDERS, IN . HOMEOWNER
oiii, i4 _/.r' d (o-o$ ^l0 �1 - �-8 /a
by, s 'ti Keiter, i p e Date Date
IP
Date
6
KEITE ' ; UILDERS, INC. HOMEOWNER
1 -'2
Aie O, -Of-10 - _ , , , —
c o t Keit ' r, it - sident Date ^ Date
Date
NOTICE:
THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES
TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY
INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS. NOT
SEPARATELY SIGNED BY THE PARTIES. THE RIGHT TO INITIATE ALTERNATIVE DISPUTE
RESOLUTION SHALL END TWO YEARS AFTER THE DATE OF THIS AGREEMENT.
MISCELLANEOUS:
This agreement is a Massachusetts contract, contains the entire agreement between us, any representations or
warranties not expressly contained in it are not a part of the Agreement, and it is binding upon our heirs,
executors, successors and assigns. This Agreement may be modified only by an instrument in writing signed by
both of us.
This agreement is subject to and is intended to comply with the provisions of Chapter 142A of the
Massachusetts General Laws and its corresponding regulations.
RIGHT TO CANCEL CONTRACT:
YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO BY
FORWARDING YOUR INTENT TO CANCEL IN WRITING BY ORDINARY MAIL POSTED, BY
TELEGRAM SENT OR BY DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS
DAY FOLLOWING THE SIGNING OF THIS AGREEMENT.
By signing this Agreement, you acknowledge that you have received a complete and original signed copy of the
entire Agreement and attached Exhibits. Keiter 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 AGREEMENT. IF THERE ARE ANY PROVISIONS WHICH YOU DO NOT UNDERSTAND,
YOU SHOULD CONSULT WITH AN ATTORNEY BEFORE SIGNING.
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You and Keiter Builders, Inc. agree to waive all rights against each other for damages caused by fire or other
perils to the extent covered by insurance.
RIGHT TO TERMINATE CONTRACT:
If the work is stopped or delayed, either in whole or substantial part, for a period of thirty (30) days under an
order of any court or other public authority having jurisdiction, or as a result of an act of government and due to
your fault or negligence, or as a result of an act within your control; or if the work shall be stopped or delayed
either in whole or substantial part, for a period of theirty (30) days due to your failure to make a payment on
time, or make Keiter Builders, Inc. feel insecure, or if you should commit a material breach of any of your
responsibilities or obligations under this Agreement, then Keiter Builders, Inc. may, upon giving you seven (7)
days written notice, terminate this Agreement and recover from you payment for all work performed; for any
unpaid costs of and fees for the work; for any liability, obligations, damages, commitments, and /or claims that
Keiter Builders, Inc. may have incurred or might incur in good faith in connections with this Agreement, as well
as receiving payment for Keiter Builders, Inc. attorney's and legal fees and all lost anticipated gross profits on
the work not performed as of the date of the termination.
NOTICE:
Notice will be deemed if delivered in hand or if sent by certified mail, return receipt requested, to the address
listed on the front page of this Agreement.
WARRANTIES:
Keiter Builders, Inc. will grant you, as part of the Total Price, a Limited Warranty, a copy of which is attached
to this Agreement. Keiter Builders, Inc. will use materials that are currently acceptable for their intended use in
performing work. You should be aware that it may be determined that some of these materials may cause
health problems. If there are any materials that you do not want used in the work, list them on the attached
Scope of Work form.
EXHIBITS:
The following Exhibits have been attached to this Agreement:
Scope of Work Limited Warranty
ARBITRATION:
THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE
THAT IN THE EVENT THE CONTRACTOR HAS A DISUPUTE CONCERNING THIS CONTRACT,
THE CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE
WHICH HAS BEEN APPROVIED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF
CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE
REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN MASS. GENERAL LAWS,
C.142A.
4
ANY DEPOSIT REQUIRED UNDER THIS AGREEMENT TO BE PAID IN ADVANCE OF THE
COMMENCEMENT OF WORK SHALL NOT EXCEED THE GREATER OF ONE -THIRD OF THE
TOTAL CONTRACT PRICE OR THE ACTUAL COST OF ANY MATERIAL OR EQUIPMENT
WHICH HAS TO BE SPECIAL ORDERED OR CUSTOM MADE, WHICH MUST BE ORDERED IN
ADVANCE OF THE COMMENCEMENT OF THE WORK, IN ORDER TO ASSURE THE PROJECT
WILL PROCEED ON SCHEDULE. NO FINAL PAYMENT MAY BE DEMANDED UNTIL THE
AGREEMENT IS COMPLETED TO THE SATISFACTION OF BOTH OF US.
KEITER BUILDERS, INC. MAY NOT REQUIRE YOU TO PAY PART OR ALL OF THE BALANCE
NOT YET DUE UNDER THIS AGREEMENT BECAUSE KEITER BUILDERS, INC. DEEMS ITSELF
TO BE INSECURE. HOWEVER, IF KEITER BUILDERS, INC. DEEMS ITSELF TO BE INSECURE,
IT MAY REQUIRE A PREREQUISITE TO CONTINUING ANY WORK THAT THE BALANCE OF
FUNDS DUE UNDER THIS AGREEMENT, WHICH ARE IN YOUR POSSESSION, SHALL BE
PLACED IN A JOINT EXCROW ACCOUNT REQUIRING BOTH YOURS AND KEITER
BUILDERS, INC. SIGNATURE FOR ANY WITHDRAWAL.
SUBCONTRACTORS:
Keiter Builders, Inc. intends to hire the following subcontractors to assist in the work:
Name
N/A
These may not be all the subcontractors that may be hired, and Keiter Builders, Inc. may decide not to hire any
one or all of the above subcontractors, which decision shall be at Keiter Builders, Inc. sole discretion.
If you ask any subcontractor to make any changes or substitute materials without first obtaining Keiter Builders,
Inc. written agreement, these changes may adversely affect another part of the work that you are not aware of
any may create additional delays and costs. If you make such changes or substitutions, you will pay Keiter
Builders, Inc. the additional cost any subcontractor charges me for such changes and substitutions, and for any
extra work and material related to your request, plus Fifty (50 %) percent.
INSURANCE:
Keiter Builders, Inc. shall purchase and maintain liability insurance for protection of all claims under workman
compensation acts and other employee benefit acts, claims for damages because of bodily injury, including
death, and from claims for damages, other than to the work itself, to the property which may arise out of or
result from my operations under this Agreement.
You shall purchase and maintain property insurance in a form acceptable to Keiter Builders, Inc. upon the entire
work and materials for the full cost of replacement as of the time of loss. The insurance shall insure against the
loss from perils of fire, extended coverage and shall include "all risk" insurance for physical loss of damage,
including without duplication of coverage, at least theft, vandalism, malicious mischief, transit, collapse, flood,
earthquake, testing and damage resulting from defective design, workmanship or material. You will increase
the limit of coverage, if necessary, to reflect the estimated replacement cost. You will be responsible for any
co- insurance penalties or deductibles. If the work covers an addition to or is adjacent to an existing building,
3
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of conservation commissions, are required to be obtained before Keiter Builders, Inc. can obtain their permits, it
is your obligation to satisfy such requirements and you shall meet those requirements at your cost.
STARTING AND ENDING DATES:
Keiter Builders, Inc. will apply for the permits within 7 day(s) of signing this Agreement or your satisfying any
conditions required to be met prior to the permits being used, whichever date is later. Keiter Builders, Inc. will
start work within 30 day(s) of obtaining the necessary permits and expects to have the work substantially
completed within 30 day (s) of starting.
If Keiter Builders, Inc. is delayed at any time, in the progress of completing the work, due to acts of God, war,
civil commotion, accident, government regulations or policies, any act or neglect of yours, or by any separate
contractor, or by change orders, or by labor disputes, fire, delay in transportation, unavailability of materials,
adverse weather conditions, unavoidable casualties, difficulty in obtaining fuel, electricity, services or supplies
from the sources from which they are normally obtained, or other causes reasonably beyond my control, then
Keiter Builders, Inc. may reasonably extend the date for substantial completion. If the work is not substantially
complete by the ending date, as extended, Keiter Builders, Inc. will not be liable to you for any incidental or
consequential damages you may incur due to such delay.
If you are supplying any materials or equipment to be used in the work, you shall have such materials and
equipment delivered to the work site not less than 5 days before they are needed for the work. If they are not
delivered on a timely basis, Keiter Builders, Inc. will not be able to schedule work dependent upon them and the
date of substantial completion will be extended due to such delay.
TOTAL PRICE AND PAYMENT SCHEDULE:
The total price for performing the work and supplying the materials under this Agreement is
Five Thousand, Two Hundred ($5,200) DOLLARS. Payments against work completed and materials delivered
will be made within 2 days from when Keiter Builders, Inc. notifies you that they have reached different
completion stages. Payments will be made in the amounts as set forth below.
1 /2 of Total Price made prior to work being started ($2,600)
Y2 of Total Price made upon substantial completion of work ($2,600)
All sums not paid before substantial completion of the work will be due and payable upon substantial
completion.
Payments due and unpaid under this Agreement shall bear interest from the date payment is due at the annual
rate of Eighteen (18 %) percent or at the maximum legal rate whichever is less. In the event that Keiter
Builders, Inc. incurs costs or expenses in collecting any payments due and unpaid under this Agreement, you
shall pay such costs and expenses including reasonable attorney's fees.
If you fail to make any payments when they are due, then Keiter Builders, Inc. may immediately stop work.
Keiter Builders, Inc. may choose to not start work again until you are current with the payments and Keiter
Builders, Inc. feels secure in obtaining the remaining payments. If there is any stoppage in work due to your
failure to pay on time, or to make Keiter Builders, Inc. feel insecure that the remaining payments will be made,
such delay shall automatically extend the date of substantial completion.
2
CONSTRUCTION AGREEMENT
Keiter Builders, Inc., of Northampton, MA whose Federal Tax Identification Number is 27 -251 -8846,
Contractor's Registration Number 163295 (Exp. 06 -01- 2011), and License #102457 (Exp. 06 -20- 2012), is
entering into this Agreement with you Tim and Anne Walko of 443 Florence Rd., Florence, MA.
ALL RESIDENTIAL CONTRACTORS AND SUBCONTRACTORS ARE REQUIRED TO BE
REGISTERED WITH THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND
STANDARDS, UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION. INQUIRIES
CONCERNING REGISTRATION SHOULD BE DIRECTED TO: DIRECTOR, HOME
IMPROVEMENT CONTRACTOR REGISTRATION, ONE ASHBURTON PLACE, ROOM 1301,
BOSTON, MA 02018 (617) 727 -8598.
SCOPE OF WORK:
Keiter Builders, Inc. will perform the work set forth in the attached Scope of Work on your home, or the
property located at 443 Florence Rd., Florence, MA. If you would like to change any work to be performed or
materials used, we will have to make such changes through a Change Work Order, which may also change the
total price and extend the date for completion. Change Orders will be handled on a time and material basis.
Keiter Builders, Inc. reserves the right to make minor changes in any plans and to substitute materials of equal
or better quality.
Should Keiter Builders, Inc. encounter any unknown conditions below the surface of the ground, or concealed
or unknown conditions in any existing structure, you will agree to make an equitable adjustment with Keiter
Builders, Inc. under a Change Work Order, which shall increase the total price and extend the date for
substantial completion of the work.
PERMITS:
To perform this work, Keiter Builders, Inc., or subcontractors hired by Keiter Builders, Inc., will obtain, on
your behalf, the following permits (if required):
x Building Permit Electrical Permit Smoke Certificate
Plumbing Permit Demolition Permit Certificate of Occupancy
IT IS THE OBLIGATION OF KEITER BUILDERS, INC. TO OBTAIN THESE PERMITS AS YOUR
AGENT. IN THE EVENT THAT KEITER BUILDERS, INC. DOES NOT OBTAIN THESE PERMITS,
AND YOU OBTAIN THEM, OR IF KEITER BUILDERS, INC. IS NOT REGISTERED WITH THE
BOARD OF BUILDING REGULATIONS, YOU WILL NOT BE ENTITLED TO OBTAIN ANY
BENEFITS FROM THE GUARANTEE FUND ESTABLISHED UNDER MASSACHUSETTS
GENERAL LAWS CHAPTER 142A.
Keiter Builders, Inc. obligation to obtain permits is limited to those permits directly related to performing the
work Keiter Builders, Inc. agrees to do. To the extent that other permits or governmental or regulatory agency
approvals, such as, but not limited to, zone changes, variances, special permits, site plan approvals, or approvals
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends 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
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation/footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is •
r, e- ,, " 'e) •. .11 , I, , , —
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
. „
7.
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The Commonwealth of Massachusetts
Department of Industrial ACcidents .
Office of Investigations •
600 Washington Street
Boston, MA 02111 . .
wvv.mass.gov/dJa
•
- Workers' Compensation Insurance Affidavit: Bnilders/Contractors/Electricians/Plumbers
Applicant Information .
Please Print Legibly
Name musineseorprdicationandividuap: VE (reIL aoic1N6-$2_5 s
')
' ' Address: 41 /21 t" - 1 -- e\Ect SC, , Nz\- 11 - 17 t+ 1 } . 4-ARsrvi1/4-) ; lAk/r
City/State/Zip: il■S .2..Ii ) OA ei Phone.#: tf ( 3 - 32_0-
Are you you an employer? Check the appropriate box: •
. - O o :
• iikr4. w _i_ 4. 0 I an a general contractor and I Type f prject (required) i 6 1 - 1.4---1 -
employees (full and/or part-time).* have hired the sub-contractors 6. e w construction
2_0 I ani a sole proprietor or partner-- listed on the:attached sheet. 7. 0 Remodeling
• ship• andhave Jig t3loyees These sub-contractors have IL 0 Demolition
working for me many capazity. ermloyeesand have wOrkers' . . • .. - -
9: fp Btindiu' g
(1■To workers conip. insurance . addition
10.0 Electrical repairs or additions 5. 0 We are a corporation and its
_ required.]
3.L.I lam a homeowner doing all work officers have f/tercisecl their . 11.0 Plunibing repairs or adthtons .
myself, No wor6is' comp. • right of exeraPtion per MGL ' •
.0 . .
insurance required.] t • c. 152, §1(4), and we have ii 12 Roof repairs
o
me .
eeS. ' 0 WOrkerS' _ .....—,.................—
' . comp. insulance reqiiirCd.j. • . . .
Any applicant-ihat checks box #1- mast IiiS0 EU out the section below showing theirworinen' compensation policy/don:I:26'm:
T Homeowners who at chock subrrat this box affudavit incrusting they are doing all work and then hire outside comm must submiia new affidavit indicatin such.
:Contract= th this mast attached an adiRtional sheet shoying the name of the suli-contracton and state wisetheror notthose entities have
employees. If the sub-contraciorslasie employees; they mustprovide tit* worimis comp. poky number.
• Lam an employer that is Provid' ing workers' compensation insurance for iny einplOyees. Below is the polic; and job site
information. . • .
Insurance Company Name: L) , (--0_.1 . ki (\l:Ls ("----, . . . ' ' • .
C . •
Policy # or Self-ins. Lic. #: Expiration Date
.
Job Site Address . 1 'I 5 t l.)(/_(-1■iCE-- P-.• ) City/State/Zip :' &-- - 6 A Ot
Attach a copy of the workers' compensation pohcy declaration page the policy number and expiration date).
Failure to secure coverage as reqiiiied Nader SeCtiii25A 152 can kaki the iMPOSitiOn OfCiiiiiii of a
fine up to $1,500.00 and/or one-year imprisonmen4 as well as civil penalties in the form of a STOP WO.P.IC.-0,11DIR and:a fine
of up to S250.00 a daY against the violator Be advised that a copy of this statement may he forwarded _to theOfIce of _.„
afeifiaiiiiiis 'r I if - for hiiiiaike'aciir -', '.' -'Veiltiiiiiiii. ,„
' .., .... :,_..., ...:- .... -I , .,..___:::::::::....,_ .,,..„
iiciitreb , r the P' - -d : , ..:'‘: ofp ti
tutt the infirntatiOn provideliTibo .
_;rrect .
__ ... rii& ' -
d o
Si tag ,tlre: •
0 . ,
, 4 / , ,A1 ' ' - - ' _ , - a ' . . -IP
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Phone #: ' L e i t — ..32-C- ' . asc • •
Official use only Do not write in this area, Lo be ciiinpleted by city Or town Official.
1 '
"- Permit/I.Acense # ' ,... .
' City or Town:
' Issuing Authority (circle one):
.1. Board of Health 2. Building Department 3. City/Tovvn Clerk 4. Electricallrispector 5. Plum bing Inspector
ii•
6. Other . 0 0 •
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : JCS Y 1 (� / L '/
License Number
fit #!;fk CD s , 04.11i6A AFr Y\ Y 0& -0 ( - 01 0 1 1
Address ) Expiration Date
Lf /3 `320 9 3-f
Sig re Telephone
9:.Re inter # €Fierttii #rrtt�r:`si �meiiltit aitet a` a � . 4 => ?,72alt
Not Applicable ❑
ke IT - ZO t L L a , J c • 16 3a5ss"
Company Name Registration Number
S7 c% j-f-i1-i et-D Sf f / ,- t L� (o -2 0 -- e� t
Address Expiration Date
Telephone ( 4 (3 3 2L
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 buil ing permit.
Signed Affidavi Attached Yes No ❑
11, y e ,fa
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 108.3.5.1.
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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) J Roofing ED
Or Doors [D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [0] Other [0]
Brief Description of Proposed ba C / a )/
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
a. Use of building : One Family Two Family Other
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
P L Eli sEE ' ' , as Owner of the subject
property
iereby authorize
act on my behalf, in all matters relative to work authorized by this building permit application.
gnature of Owner Date
c _0 - 71 --- 14E ; E- , as Owner /Authorized
ent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
1 belief.
ned under the pains and penalties of perjury.
S Cor T ---
Name
0C2- Date
itu o /Agent
Sec tion 4.
2 O/y/N G
All t nfo --con M� .
' Lot S • r Be Co�Pteted Pe
rn Ca Be
� r °e gied p
°posed ue To in
Se ba Required Ptete tnformati
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P This coi b 20
\ guil� oeAa y e � ed i n
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Side L .----_, r
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dg * Squa F4 ~.• ,� "-------1 Cben a ge '` - -
O e S lit1fi�R„it° e 1
# of Parkin: S . ace
8 % (11111: /
Fill: f ---- - „,, , 1
volume & Location _ „,` " { t
A. Has a Special Permit/Va :- ----. 141/4111***if
NO 0 DONT KNO.
IF YES, date issued:1
IF YES: Was the permit recorded at the Reg issued
NO 0 DONT KNOW 0 - ( f o ry on the si
IF YES: enter Book
B. Does the site contain a brook, body of water or wetlands?
IF YES, has a permit been or need to be obtained from the Con.
Needs to be obtained ® Obtained 0 , De
C. Do any signs exist on the property? YES Q NO ® `"it # ..._ `` x - .
IF YES, describe size, type and location: ? _...___.
D. Are there any proposed changes to or additions of signs intended for the property ? YES a
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 pt,,
that will disturb over 1 acre? YES 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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eat; Cost (Dollars) to be
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This Section For official Use OnI
Date
ermit Number
Issued:
Date
Building Commissionerfnspector of Buildings
File # BP- 2010 -1112
APPLICANT /CONTACT PERSON SCOTT KEITER
ADDRESS/PHONE 51B HATFIELD ST NORTHAMPTON (413) 320 -9035
PROPERTY LOCATION 443 FLORENCE RD
MAP 30C PARCEL 009 001 ZONE SR(100) //WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out (..5
Fee Paid
Tvpeof Construction: CONSTRUCT 12 X 16 DECK
New Construction
Non Structural interior renovations
Addition to Existing_
Accessory Structure
Building Plans Included:
Owner/ Statement or License 102457
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
6//0/i6)
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
443 FLORENCE RD BP- 2010 -1112
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30C - 009 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -1112
Project # JS- 2010- 001632
Est. Cost: $9300.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SCOTT KEITER 102457
Lot Size(sq. ft.): 85029.12 Owner: WACKO ANNE & TIM
Zoning: SR(100) / /WSP Applicant: SCOTT KEITER
AT: 443 FLORENCE RD
Applicant Address: Phone: Insurance:
51B HATFIELD ST (413) 320 -9035
NORTHAM PTON MAO 1060 ISSUED ON: 6/10/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 12 X 16 DECK
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 Signature:
FeeType: Date Paid: Amount:
Building 6/10/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
443 FLORENCE RD BP -2010 -1112
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30C - 009 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -1112
Project # JS- 2010- 001632
Est. Cost: $9300.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SCOTT KEITER 102457
Lot Size(sq. ft.): 85029.12 Owner: WAIO ANNE & TIM
Zoning: SR(100) //WSP Applicant: SCOTT KEITER
AT: 443 FLORENCE RD
Applicant Address: Phone: Insurance:
51B HATFIELD ST (413) 320 -9035
NORTHAMPTONMA01060 ISSUED ON :6/10/2010 0 :00 :00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 12 X 16 DECK
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: i 6 4 \ (O x 1S
Rough: Rough: House # Foundation:
tt
Driveway Final:
Final: Final: i s i , e -g s
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: 0K 1 2 1( (0 1.0441
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
;6 .4..
Certificate of Occupancy 2 . Id Lcna ., 4atri,ignature:
FeeType: Date Paid: Amount:
Building 6/10/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo