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WB3033 W63018 WB3033 fir( a )) BB33 B833 30 RANGE!; BD18 041 BER36L !�� rn ~ ... .—'7—.7 _1 U 4 'A T': -m- BB33.02 609E I N3 M MZ 1 BFH42.12 �I - ' �--- -,42" r j j I ' A i i c l I I j i 3 �—i Ir^1 ii All dimensions size designations This is an original design and must Designed 11/29/2011 given are subject to verification on not be released or copied unless Printed: 11/2/20 15 fi Job site and adjustment to Fit job applicable fee has been paid or job conditions. order placed, i i i !ones opt I All CQ'-1" 0 JONES September 26 2015 Description Cost Appliances i x Caoinets&Counters Knoos!Pulls 1 d f Plumbing r . HVAC HVAC-Carpentry Electrical Project Total 541,936.113 V e appreciate your busirlesS and look forward io working witfl you k Iro4 , E3�� �2te --�----- Contractor ,�ic �l .Gi;rr t J':_ter S, It:; _i',-'1ST .r � ;�:„ •_ JONES September 28, 20!5 Scott Keiter Kelter Builders, Inc 35 Main Street _ .--- Fiorence, MA 01062 f Off ice 413.586 8600 r Fax 413.280.0124 scottkeiter«,gmaii.com ' B U I L D E R S' .vww KetterBuilders.com License # 102457 Project Customer JONES Barbara Jones Mobile 413-537-0160 44 WESTHAMPTON ROAD n4 Westhampton Road bdjones55C4rgmail.com FLORENCE, MA 01062 Fiorence. MA 01062 KITCHEN REMODEL Description Cost Building Permit Demolition& Debris Removal Project Isolation Site Breakdown Site Set-Up Cabinet installation Change Opening Floor Demolition Misc.Carpentry/Blocking i Framing Relocate Existing Shelf Unit yr 3: Harawood Floor Tile Backsplash Cons :f1I IL )ICIC Ilj�� ol tile llh,ill jnid 1, J\ ;Io�l ,yolk unill •dtcr ti)], DO NOT SIGA THIS •OATR 1 CF IF TIIVRF Y BL. 1A K S11. I RIND/A G A - THIS IS A LEGALL Y GREE.M."Ni'. IF I'llf-Wh tRL'. IN) PROJ 1NIOA YOU NOT UNDERSTAND, YOU SHOULD COAST 1,T WIT11 IN A TTOR VLT B[,FORT'Sl(;A-[v(;. KFATER RIALDF (MNER ----------- bN—Scott Keifer. Pr usi(leill -------- Date KIATEIZ Mv IV v R BN SCWt )a I • lie)I 0 TICE: j)Afj Ill S \Ij( )Vj A( Th I A!WF ( 4 11H PRN,\ I IV! fusp! I1 1\1 I LA I I AL I I 1\ I: Ill WA\I-R \LAY SKPARAIKY Sl(,i,\l IM H M lllil� SI.,( [ IO\ is MY] 13) 1 )H jj\RIjI,S ' 'IF 1=11 M INIIIAIT M WITNADVI IMSP( IL RFSOUAWN MIALL KND M) A IRS AF WIT I1 fl. !) \ Ii Of I !f1,1_1 AORLFAIF,,,'-I . \0 TICE: I I it SIGN A 11 IRF's or 1 li N AROI, lc \PPI I Y I OF I ILL p.\i:] If's Sl I..1 1 LNIJ \1 1NIMI PI) Ry IIH (A)N I it A(q , H& I 1 H \1 TFIRVY IV! DINO , I I � ;A1 11_A ALFFRNAII\ h DISM If RI A i A DA KIN " jqyp 11"S SFUMN IS N01 Sl P \R \ I FL) SHAK 1) fly 1 111 p \Mjl �, 1111 RIUll' 10 1\11 L\ I F R1 SOL! J ION SIIAIJ FNIMMUMN .011 R FIT DMIjol: VIIIS \(jR[,l M IVIANATIVI, FASITTL WS(ELL INE01 8: Fhi� i,, 1 :,11c Cf f li�icCn11:111 u-, 111!1,;,37ticS nol J,�Ir; o! thy- A�-,[?,:clflCnl. And ii MCCLIlors, SUCCCsmw1 and isopm. 1 Ili` mo) hC nhilked 0my by in smote( by 1�i0ni 0I ( haj)'.(21 142 OCI)CI-al I a\\S and its C( nee Lin,h.'r,,tands And wkn""QTn Hot KCHU lluildm, Inc ma�\ tlSL, ,Iny inil" ill�:Iudc. hat i� n''t to, [FL, all", llkcr> R16117' TO CAAC •L COA TRA( /-,- M1 MAY (AMY. TJ FIS v A pr%IF \ I j! 1 SlipAI I) 131 N I' A 1Y T!IM I u 131 I'"R"RUING )!" IN 1 " ! 10 C "d I IV I)l\ MY NLAIJ PON I LIT jjy IF! PURATI SFYJ OR R) 1p I V1 Ry. A! ) i 1 \ IpH IIL,\ 41(A L'A i ( T 11 i 14 1.i R! F '`��Rte® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/YYYY) 7/10/2015 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 NOAMP Cynthia Henderson, CISR Webber & Grinnell PHONE (413)586-0111 rAx N (413)586-6481 - xc - - 8 North Kin Street E-MAILchenderson@webberandgrinnell.com �] ADDRESS:...--- _INSURER(S)AFFORDING COVERAGE _ NAIC q _ Northampton MA 01060 INSURER AArbella Insurance Group17000 INSURED INSURER B__ Keiter Builders, Inc. INSURERC_ Attn: Scott Keiter INSURER D 35 Main Street INSURER E Florence MA 01062 INSURER F COVERAGES CERTIFICATE NUMBER:Master Exp 2016 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. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER M D/YYYY M D/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE A CLAIMS-MADE ❑ OCCUR PREMISES(E. .."an.) $ 300,000 8500064396 6/1/2015 6/1/2016 M_ED_ EXP(Any one person) $ 5,000 �I 1 4 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL .. $ 2,000 000 ' GEN'L AGGREGATE LIMIT APPLIES PER: !. X POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG 2,000,000 JECT --- OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED _ AUTOS X AUTOS 1020039381 6/1/2015 6/1/2016 BODILY INJURY(Per accident) $ I NON-OWNED PROPERTY DAMAGE $ l_X HIRED AUTOS X AUTOS _(Peracciden1 Medical Pavments $ 5,000 X UMBRELLA LIAB I CLAIMS-MADE EACH OCCURRENCE __. $ 1,00000 I A EXCESS LIAB �� ,AGGREGATE $ __ 1,000,000 t._.._ ---- .. X T 4600064399 6/1/2015 6/1/2016 DE D RETENTION 10,0 00 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY 1 STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/ A E.L.EACH ACCIDENT _ $ _ 100,000 OFFICER/MEMBER EXCLUDED? A (Mandatory in NH) I 9127440615 6/11/2015 6/11/2016 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below i I DESCRIPTION OF OPERATIONS/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. AUTHORIZED REPRESENTATIVE C Henderson, CISR/CIN .- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSn95 rgnienrn The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations I Congress Street, Suite 100 bti Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Keifer Builders, Inc Name (Business/Organization/Individual): 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): 1.9 I am a employer with 15 4. 0 I am a general contractor and I 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. 8 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workers'd h employees and wor r working for me in any capacity. 9. 0 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 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 till 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:Arbella Policy#or Self-ins. Lic. #:9127440615 Expiration Date:6.11 .16 Job Site Address: 44 Westhampton Rd 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 under the pains and penalties of perjury that the information provided above is true and correct. 11 .5.15 Si nature: ! Date: Phone#: 4 .586.8 00 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#: 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: 44 Westhampton Rd The debris will be transported by: Kefter Builders, Inc The debris will be received by: valley Recvcllna Building permit number: Name of Permit Applicant Keiter Builders, Inc 10.30.15 Date Signature of Permit Applicant 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 Add re s Expiration Date 413.586.8600 Si ture I r Telephone 9. ReaisteredHome Improvement Contractor: Not Applicable ❑ Keiter Builders Inc 175168 Company 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(I) 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 Alteration(s) Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs El] Decks ❑ Siding[]] Other[[J] Brief Description of Proposed Kitchen Remodel Work: Alteration of existing bedroom Yes X No Adding new bedroom Yes X Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet 6a. If New house and or addition to existina 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 I, Barbara Jones 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 11.5 15 Signature of Owner Date NOR 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 Na 11.5.15 Si ture of Owne gent 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? YEF O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit': Building Department Curb Cut/Driveway Permit_ 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans � p on 413-587-1240 Fax 413-587-1272 Piot/Site Plan Vol s Other Specify APPLI hi "tC�r NSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 9E SECT -SITE INFORMATION This section to be completed by office 1.1 Property Address: Map "'Lot Unit 44 Westhampton Rd, Florence MA Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Barbara Jones 44 Westhampton Rd Name(Print) Current Mailing Address: 413.537.0160 cj"j 51 Telephone Si nature 2.2 Authorized A ent: � VA I SXS vt.L Name( rint) Current Mailing Address: g to Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building $41 ,936.18 (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) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0634 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE01062(413)586-8600 Q PROPERTY LOCATION 44 WESTHAMPTON RD MAP 43 PARCEL 108 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: REMODEL KITCHEN 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 INF03MATION 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 Signature of Buil g fficial 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. 44 WESTHAMPTON RD BP-2016-0634 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:43 - 108 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2016-0634 Project# JS-2016-001055 Est.Cost: $41936.00 Fee: $272.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq.ft.): 52707.60 Owner: KONOWITCH MARTIN&BARBARA DICKEY JONES Zonine: Applicant: KEITER BUILDERS AT. 44 WESTHAMPTON RD Applicant Address: Phone: Insurance: 35 MAIN ST (413) ';9-6-8600 O WC FLORENCEMA01062 ISSUED ON.111912015 0:00:00 TO PERFORM THE FOLLOWING WORK.REMODEL KITCHEN 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 11/9/2015 0:00:00 $272.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner