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32A-072 AR D CERTIFICATE OF LIABILITY INSURANCE DATE(MMID13/YYYY) 6/11/2013 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 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 Cynthia Henderson, CISR Webber & Grinnell (PAH„°ONE Exn. (413)586-0111 I t No):(413)586-6481 8 North King Street /@-MAIL chenderson @webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL# Northampton MA 01060 INSURER A:Travelers Companies, Inc. INSURED INSURER B:Citation 40274 Reiter Builders, Inc. INSURERC:Travelers Indemn. Co. CT 25682 51A Hatfield Street INSURERD: INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATENUMBERMMaster Ezp 12/13 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR INSURANCE ADDL'SUBR POUCY EFF POLICY EXP TYPE OF INS LTR INSR WVD POLICY NUMBER (MM/DWYYYY) (M•IDD/YYYY) UMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY 1 PREMIX(occurrence) $ 300,000 A I CLAIMS-MADE X OCCUR 6806319N6611342 6/1/2013 6/1/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 ]C i POLICY I-7 P,ITT- []inc $ AUTOMOBILE UABIUTY (Ea accident) GLE LIMIT $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED x SCHEDULED 12MMBCDRO7 12/21/201212/21/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS — B HIRED AUTOS X AUTO WNED (Per accident)AMAGE $ Medical payments $ 5,000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION I )AC STATUH YIN - AND EMPLOYERS'UABIUTY TORY I!NITS FR ^ ANY PROPRIEfOR/PARTNER/EXECUTIVE l l N/A (Mandatory In EL EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? 1103112A56578213 6/11/2013 6/11/2014 EL DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY OMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,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 Information Only ***** AUTHORIZED REPRESENTATIVE C Henderson, CISR/CIN 'lG `04.`y'^ ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSm95 r,namct m The Af_fPr1 names snri Inn^area ro^iefnrn,l market^f At(1Rfl BUILDERS SCOPE OF WORK December 06. 2013 CUSTOMER NAME: Zoe Pappenheimer ADDRESS: 19 Union Street, Northampton, MA ESTIMATED START DATE: Winter ESTIMATED PROJECT RUN TIME: 3—5 Days WINDOWS (Please see attached Paradigm quote# 194487 for window specifications) This contract includes the following: • Permit application. fees. and inspections. • Installation of(I S t \■indov' inserts. this includes the follov,ing: o Remoy al%disposal of storm units. existing sash units.and misc. components o Preparing the opening to accept new u■indo■■ units • Installation of nee\ inserts to all manufacturer specifications and guidelines All caulking and ‘+eather sealing • Installation of lows expansion foam insulation around new insert unit c Installation of fiberglass insulation in an ■■indolA weight pockets Installation of neon inrcri■)r wincluu crop.o • l:'I'.1 RI??Lead Sole I,i iulluthnn_ • Please note that the follo■■ing are not included: An, painting,nail hole filling. stain. poly urethane.or other finishes. • Owner is responsible for removal and re-installation of'%indouo treatments(blinds.etc.) • Rot repair will be hanclleci u+r ,r time uncl material basis, Keifer RuiOers char dc's Sill /It no-li>r labor arxi murky all ntcNerial.� up by l?":, PRICE FOR li'IVDOII S(Including Tax): 56,759.00 PRICE FOR PE_RA/IT, :I/ISCF_LL:•I.A'EOC'S MATERIALS,.-1 ND LABOR: S4,375.00 TOTAL PRICE FOR LABOR AND MATERIAL: 511,134. 10 2. Q r . � . 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. KEITER BUILDERS, INC. OWNER 2,A /Z-- O ce - 2 o 1.2 -V 3 b ,S►,tt iter, President [)ate Uate Date (loll`:,i 6 approvals. such as. but not limited to. zone changes, variances. special permits. site plan approvals, or approvals 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 15 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 i0 day(s) of obtaining the necessary permits and expects to have the work substantially completed within 5 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 he 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 Eleven Thousand, One II undi td and Thirty. Four Dollars (511,134.00) DOLLARS. Payments against work completed and materials delivered will he 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 in the attached payment schedule. 60% of window cost (incl. 5% mark-up) due with signed contract (54,055.00) 40% of window cost + 1/3 labor& misc. material due prior to initiating work (54,016.00) Final payment due at Substantial Completion. (S3,063.00) All sums not paid before substantial completion of the work will he due and payable upon substantial completion. Payments due and unpaid under this Agreement shall hear 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 ally 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 BUILDERS' SCOPE OF WORK December 6, 2013 CUSTOMER NAME: Zoe Pappenheimer ADDRESS: 19 t!nion Street, Northampton, MA ESTIMATED START DATE: Winter ESTIMATED PROJECT RUN TIME: 2--3 I)ays WINDOWS (Please see attached Paradigm quote# 194488 for window specifications) This contract includes the following: • Permit application. tees,and inspections. • Installation of(3}ne++ construction +cindo's'. This includes the folio++ing. Demolish and rento+c all interior trim,exterior trim.sash.and misc. Prepare rough opening to accept ne+■ construction unit Any misc. dr+++all repairs o All flashing. sealants, insulation. etc. Install ness V,111(1)1A to manufacturer specifications Ne++ exterior and interior ss nrdo++ trim • EPA RRP Lead Safe Installation. • Please note that the following are not included: .An,+ painting, nail hole tilling, stain. pol}urethane.or other finishes. • Owner is responsible for reno+ai and re-installation of++indow treatments(blinds. etc.) • Rot repair++ill be handled on a time and material basis. Keiter Builders charges$50'hour for labor and marks all materials up h■ 15'11) PRICE. FOR WINDObf S(Including Tax: 51,375.00 PRICE FOR PERMIT, MISCELLA,VEOUS MATERIALS,AND LAB OR: 52,550.00 TOTAL PRICE FOR LABOR AND MATERIAL: 53,925.00 By signing this Agreement, you acknowledge that you have received a complete and original signed copy of the entire Agreement and attached [xhibits. 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. KEITER UILDERS, INC. OWNER i , 2-- - h , Sco Keiter, Pr . '+ent Date Date 1 Z —7-► 3 Date 6 approvals. such as. hut not limited to. zone changes, variances, special permits. site plan approvals, or approvals 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 A ND ENDING DATES: Keiter Builders, Inc. will apply for the permits within 1.5 day(s) of signing this Agreement or your satisfying any conditions required to he 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 5 day (5)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. tire, 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 he used in the work, you shall have such materials and equipment delivered to the work site not less than > 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 Three Thousand. Nine Hundred and Twenty Five Dollars (53,925.00) DOLLARS. Payments against work completed and materials delivered will he made within 2 days from when Keiter Builders. Inc. notifies you that they have reached different completion stages. Payments will he made in the amounts as set forth in the attached payment schedule. 60% of window cost (incl. 5% mark-up) due with signed contract (5825.00) 40% of window cost + 1/3 labor & misc. material due prior to initiating work (51,400.00) Final payment due at Substantial Completion. (51,700.00) All sums not paid before substantial completion of the work will he 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 pay ments due and unpaid under this Agreement. you shall pay such costs and expenses including reasonable attorneys 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 2 - • .® • - CITY F NORTHAMPTON • Construction ri Affidavit In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting.from any work = : - -__-_ -cover-ed:by-a-Building Permit-shall be d isposed-of-in a-properiy licensed disposal facility, - as defined by M.G.L. c. 111 § 150A. � • Address of Work: / / d — /&/D i;--k 4./ l"6A" v(6 (,6 --The-debris-will.be-transported by: / 114 G • The debris.will be received:at:. VA-a( G --—`- — - Signature of Permit Applicant 4.l �--- — ' - Date ����� Building Permit Number: - • • • • • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information l !® rint Legibly Name(Business/Organization/Individual): /fie /-1-e// llil-e 5/��, 7 G • Address: 5/ A- �T�- ( mil -ET. City/State/Zi . D r' frivi-cfri f4 OM&O Phone#: L/C. ..g? ' -g 06 Are ou an employer? Check the appropriate box: Type of project(required): 1. I am an employer with rp 4. ❑ I am a general contractor and I 6. 0 New construction employees(full and/or part-time).* have hired the sub-contractors 7. ❑ Remodeling listed on the attached sheet. 2. ❑ I am a sole proprietor or partner- These sub-contractors have 8. ❑ Demolition ship and have no employees employees and have workers' working for me in any capacity. comp.insurance.$ 9. ❑ Building addition [No workers' comp.insurance 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its officers have exercised their 11.❑ Plumbing repairs or additions 3. ❑ I am a homeownerSeattle8 doing right of exemption per MGL c. 12.❑ Roof repairs all work myself. [No workers' 152,§1(4),and we have no comp.insurance required.]t employees. [No workers' 13.I f� Other Q P4?e-e Me it"I- comp.insurance required.] (A)1' rk.15 *My 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. � Q Insurance Company Name: ( tea V-r- &V k `a- K C-'( Policy#or Self-ins.Lic.#: .L Eu/39/1-5e05 7 0 / ' Expiration Date:/(-401/40t.-04/01-674_6`1�'C2 0/ ^ Job Site Address:All IA� ion�T2' �— City/State/Zip: ///T O/0&O 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 'rtify u d, the pains and penalties of perjury that the information provided above is true and correct. - Signature:I/ �� Date: /° fib //-5 Phone#: WIIII7/3 - 58 a-- 'S ' O 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#: Z:\Workers Comp Aff-Highlited.doc SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: SCoTT e(T E- G/o - /&P '/5 7 License Number 5/ A- ( it--4:e Q1 146_, ►% A_k,,_- W i Addr:ss Expiration Date I'1 'r/ A4< ,fr,_._._.____ .z.//,5_ 5-i& ---z ?e,D-O ature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ K.61�e �r a e V C • / 75/ F panv Name Registration Number 57 A- - ,1( Yri A el-kit-Imp'/?)-),v z--/p1 //c)--. ._5 P Address Expiration Date Telephone-D &"D 6 66 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. )(ft Signed Affidavit Attached Yes 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 1083.5.1. 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 4, SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacementin bows Alteration(s) J Roofing El Or Doors ] Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks ❑ Siding El] Other[El Brief Description of Proposed Work: /g Ke f C-e (k 6\) 3 . Alteration of existing bedroom Yes X' No Adding new bedroom Yes - No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: 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 ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1,14 akr eG>c g -2 I! V uf. (/I/lG . i ,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. Sign:/un•-r the •-ins nd penalties of perjury. •r t -me /6 /3 Signature of Owner/Agent 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 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ay DONT 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 e 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 IF YES, describe size, type and location: E. WiII 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? YES O NO q) IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only EH) � P, fr,.,, �� - ity of Northampton Status of Permit: rim ; — ��� -i ri uilding Department Curb Cut/Driveway Permit ' I i'; 212 Main Street Sewer/Septic Availability i. DEC 1 7 2013 Room 100 Water/Well Availability _ ___. i N rthampton, MA 01060 Two Sets of Structural Plans phone,41 -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 ,iq t)yL SI-Ye e -6.- Map Lot Unit nY- tiGtMu - 6/0& e Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Zoe ?aePR- Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Anent: JeA - K.e r-f-e►-, Pre s. 1<e r -ell 3(41/o(-evs (or. 5I A { -�-dd .�--[: t�6 -{ -_ Name(Print) Current Mailing Address: / `/1 • 5g & -8060 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building /5;051. eD (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 6. Total=(1 +2+3+4+5) /5 05q. as Check Number c77617/�q? $3S This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 19 UNION ST BP-2014-0731 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-072 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2014-0731 Project# JS-2014-001242 Est. Cost: $15059.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SCOTT KEITER 102457 Lot Size(sq. ft.): 9365.40 Owner: PAPPENHEIMER ZOE Zoning:URC(100)/ Applicant: SCOTT KEITER AT: 19 UNION ST Applicant Address: Phone: Insurance: 51A HATFIELD ST (413) 320-9035 WC NORTHAMPTON MAO 1060 ISSUED ON:12/17/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 18 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 Signature: FeeType: Date Paid: Amount: Building 12/17/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner