24C-170 KETAY December 28. 2014
K8iterBuild8r- Inc.
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Florence, K4A01OD2
Office 4135868800
Fax 413,280,0124 KEITER
smttkaiiarVggmaiioom
www.RekerBuik1ers.onm
License#: 102457
Project ' ` ` / ' � �� �-- - ---- �----�--_-_-_r----�
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� KETAY SannhKatay Mobile G312413177
07 FRANKLIN STREET G7FranNmShee aenahke�y(�-- innm
N[>RTHAyWPTON. K�A01U0O No�hannpnon. MA81O00 u'''~'�
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Notes:
REVISED 12-31-14
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---- - ----- -----'-----
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Project Total 14.613.26
--------------------------
Approved By, Date: ---'12,,28/14_' Date:
Contractor -v ' -........ Customer
_-
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xaxe/8u/ldem. Inc, License 102457 �
[IV signing this Agreemeilt. VOU ackn(
entire Agreement and attacil' '"'edge that vou hz1vc received a complete and original signed copy of the
t, attached f x1libits. Kciter Builders,
been signed. "'aY 110t Start WOt'k Until after this Agreement has
D -'VO
0 ; T SIGN THIS COA"TRACT IF THERE ARE ANY BLANK Sp, CF
B1A"DhVGAGREF_,VjEjy7,. It, THERE ARE AN11PROtj,510,,VS +,IlCll THIS IS A LEGALLY
YOUMIOU'LD CO.,V,'VULT�JIT]l�4NATTOR�,Vl,-yBF-FOREvl(;IN,"IV(;, YOU DO 2VOT UA;DERSTAjN!D,
KFITU,R BUILDERS, INC. OWNER
Cott Keiter, f'resident
Date
rX -Z
Date
. ....................................
Dat
k:EFFER BUILDERS. INC, OWNER
Cott Kest f, President Date
- Date
ae
r1W TICS:
. ...................
I H SIGNATt RE.S OI I-II.I PAR IFS A13OVE :%PPL ONLY I(:) "II TL? _A(JRREENIEN I`Oi-' THE PARTIES FO AL.T( RNAIIVE DISPt.1.1,' SF:7 1 LT-,�'I( t I�TII�� 1T_D F3Y i-1IE� C'ONTRAC°1"OR. THE OWNERMAY
INITIAT} Al.. }I R.N;ATIVI: DISPL,M RE:S{)I.I ITION FVf,N %NHERE THIS SECTION IS NOT
SEPARA THLY SIGNED BY "1"111 PARTIES. HII RIGHT .1'0 INITIATE ALFFANATIVE DISPUTE
RFSOL UMON SHALL END TWO YEARS AFTER TJ� If DATE OF THIS AC,RL:C>MENT.
._........_.
TI IL SIGN A"I-t.Rl S 01'. TI IL PART 11"S AB04`E� API'l._Y C)NE.A' �I t.) "I f II AGRUME NT Ol.' 'I'liE. PARTIES
TO AL.TE;RNATI f: D(Spt�TL SE"I 1 LEi�F1I VI I SIT I1"If-;I_T 134` LIIF: CC1�"IRAC'"I`t3R. IT OVN R MA Y
"HON :1 FN tk IT :R} THIS SECTION
INITIATE' \L ERNATIVE DISPUTL RISUItI.
IS NOT
SF::PARA IFLY SIGNED By
"I'}IE PARTIES. I EIh RIGHT TO INI`I'IA'I"I: ALTERNATIVE DISPUTE RESOL(t ION SHALL END TWO R
DATE OF THIS AGRE;E;MI:NT.
HSC'ELLA;VEOG:S:
This agreement is a Massachusetts contract. contains the entire agreement between us, any representations or
warranties not elpressl� contained in it are not a (girt of the Agreement, and it is binding ulx)n our heirs,
executors. successors and assigns. Ihis .Agreement may he modified onh, bN an instrument in tiv�riting 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 cori-csponding regulations.
ONvner understands and aci:mmledges that keiter Builders, Inc. mm use any photos taken during the course cif,
work tier promotional purposes. This tnt�� include, but is not limited to, the following: Website. newspapers,
.journals. magazines, posters, and tivers.
RIGHT TC)C CEL_CC1;t'Tk4Cf:
YOU C"ANCEL.. THIS \GRL?} 11l-'N " IF 11' HAS BFFN SKIM`[) BY A PARTY THERETO BY
FORWARDING YOUR INTENT TO C.'ANt }:1., TN %VR:TT"INGr BY ORDINARY MAIL POSIT-II), By
'11,.:1 E;GRAM SENT OR BY DEI:IVVRY� Nt: F L:VYLIZ THAN f\IIDNIGHT OF TT-II THIRD B1.17SINESS
DAY FOLLOWING ] LIT; SIGNING; OF THIS AGRVFI ME:NT.
ti
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: &a "',� S�
The debris will be transported by: (-rUtk &V Ides
The debris will be received by: x&eq Ott-
Building permit number:
Name of Permit Applicant S6o- y (C(Ay
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' l Congress Street,Suite 100
r Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information f� Please Print Legibly
Name (Business/Organization/Individual): il L�� , �✓LC _
Address:
City/State/Zip: (of-f 6 U ld6�)- Phone #:
Are you a employer? Check the appropriate box: Type of project(required):
1.E411 am a employer with 10 4. ❑ I am a general contractor and 1 6. ❑ New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their l l.❑ Plumbing repairs or additions
myself. No workers' com right of exemption per MGL
y [ p. 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.F1 Other
comp. insurance required.]
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
I 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.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. 0
Insurance Company Name: ca_L/Z(0-'r-S
Policy#or Self-ins. Lic. #: ��ls(I�j�I�Sr6��'ga �'( Expiration Date: 6 It( It r
Job Site Address: [7 EI ay\yl K S�- City/State/Zip:./,/)yjtALA� r/( A
U(06,a
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 ce ' under the pains and penalties of perjury that the information provided above is true and correct.
Signature: � .�S [ Date: t
Phone#• (� 6 r 6 �
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#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: .mac 10 4 �.{ /-0.<�, — 16 L [ J
License Number
af44CkXAefiL-\ ly6d 6
Address Expiration Da et
S ture Telephone
9.Registered Home Imorovement Contractor': Not Applicable ❑
Company Name 1 Registration Number
5—t 6 ll-"Iev` +- /U�'�7�'rl d1o6O L//a---//I S-
Address Expiration Date
Telephone y/3
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....... No...... ❑
11 - H6rn1 Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(l) 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 suuervisor.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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable
New House ❑ Addition ❑ Replacement W' doves Alteration(s) ❑ Roofing F7 Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0) Decks [lam Siding[0] Other[0]
Brief Description of Proposed /
Work: ea(aCC �-*
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓ No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.If w o' i to i` comtkte t the fot o
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
I,- _ -Ll -Gl.L'\- , as Owner of the subject
property
hereby authorize -1-1 y 1 l)" Oce r 5 r '✓l C
to act on my behalf, in aT rs relative to work authorized by this building permit application.
See c,cAu-deck eoyv+u.c4
Signature of Owner V Date
I, (Ve/f &)-Ah r.5 i i,l c 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.
Print Name. 'Pies i dA,, ku'�y In
Sig4kure 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 a er been issued for/on the site?
NO 0 DON'T KNOW Ili& YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Regist of Deeds?
NO DON'T KNOW YES 0
IF YES: enter Book Page and/or Document#'
B. Does the site contain a brook, body of water or wetlands? NO � DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO @/
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES NO -�
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavaUon, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Dep rtment use aniy,;
ity of Northampton Stair off�errbtc
ilding Department trfts`Cul1ewY emit
.12 12 Main Street Sewerty t Avaiiat hty
~ -
�� jM —8 MS Room 100 Watef !lfeilAua(JyI
b
{{ !No hampton, MA 01060 Twa of Stru tttraI Plans
t - phone 41 87-1240 Fax 413-587-1272 PiatStte;Plans
Clec'.~I f
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
6"- cy-a \K Uv\ 5+ Map Lot Unit
/U o Y 4 k am&, km W Zone Overlay District
o106d
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED>AGENT
2.1 Owner of Record:
Name(Print) `1 /1 Current M,3ailing C2 9s: _ 3 1
-t.TTc.w e-S Sl�� Gfi--,1�r[.L Telephone [�—t a
Signature Ij
2.2 Authorized Agent:
,(-R4ef c4f S. 1 vtc, 3S MoL l,& S �-- o e vice. VU IA- 01b6 a..
Nam (Print) Current Mailing Address:
�
i'3-�g6- 9 Gov
S ature Telephone
SECTION 3-ESTIMATED CONSTRUCTION'COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ' �< a b (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) / 6/ . C1-& Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/inspector of Buildings Date
67 FRANKLIN ST BP-2015-0713
GIS#: COMMONWEALTH OF MASSACHUSETTS
MU:Block: 24C- 170 CITY OF NORTHAMPTON
Lot: -00 L 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-2015-0713
Project# JS-2015-001382
Est. Cost: $14613.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SCOTT KEITER 102457
Lot Size(sq. 1): 6011.28 Owner: KETAY SARAH
Zoning URB(100) Applicant: SCOTT KEITER
AT.• 67 FRANKLIN ST
Applicant Address: Phone: Insurance:
5 1 A HATFIELD ST (413) 586-8600 O WC
NORTHAMPTONMA01060 ISSUED ON.11812015 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 17 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 1/8/2015 0:00:00 $35.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner