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24C-048 (2) 21 WOODLAWN AVE BP-2019-1318 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C-048 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pennit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Ceteeorv: renovation BUILDING PERMIT Permit# BP-2019-1318 Project# JS-2019-002127 Est.Cost:$200000.00 Fee: $1300.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License. Use Groan: KEITER BUILDERS 102457 Lot Size(sa. ft.): 35893.44 Owner: ROTH RATZ MATTHEW&ESTHER Zoning:URA(100)/ Applicant: KEITER BUILDERS AT: 21 WOODLAWN AVE Applicant Address: Phone: Insurance.- 35 MAIN ST (413) 586-8600 O WC FLORENCEMA01062 ISSUED ON.512412019 0:00:00 TO PERFORM THE FOLLOWING WORK.•KITCHEN REMODEL,NEW DORMER,NEW ROOF 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: FeeTvpe: Date Paid: Amount: Building 5/24/20190:00:00 $1300.00 212 Main Street,Phone(413)587-1240,Fax:: (413)587-1272 Louis Hasbrouck—Building Commissioner File 9 BP-2019-1318 APPLICANT/CONTACT PERSON KEITEI 91JILDERS ADDRESS/PHONE 35 MAIN ST FLOP] .ICE (413)586-8600 Q PROPERTY LOCATION 21 WOODLAWN AVE MAP 24C PARCEL 048 001 ZONE URAtt-90II THIS SECTION FOR OFFICIAL IBE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TmeofConstruction: KITCHEN REMODEL.NEW DORMER.NEW ROOF New Construction _ Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included Owner/Stwement or License 102457 3 sets of Plans/Plot Plan THE FQGLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN TION PRESENTED: ____Approved_Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:J Intermediate Project•.Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Pian ZONING BOARD PERMIT REQUIIIIED UNDER: § Finding Special Permit- Variance* Received&Recorded.at Registry of Deeds Proof Enclosed Other Permits Required: ,Curb Cott from DPW Water Availability Sewer Availability TSeptic Approval Board of Health �Well WaterPotability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Damolidan Delay N /' 2 Signature o uildhtg OO1 c T Da _._..-__—.- Note: Issuance of a Zoning permit dots not relieve a applicant's Morden 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. I Variances are granted only to those applicmte who rnoet the strict standards of MOL 40A.Contact Office of Planning&Development for more information. mar VED Department use only City of No am ton Si tus o Pe it. Building De art entppy 2 0 2019 Cu Cu nv y Permit 212 Main tr t Se r/S tic Availability Room 00FBNtO1NOlNSFE Y4t*/N (Availability Northampton, A®tim of Structural Plans THPMFTON.MPnt phone 413-587-1240 - Plot/Site Plans"". Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot og i Unit 21 Woodlewn Ave I Zone Overlay District Elm SL District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Esther& Matthew Roth-Katt 21 Woodlavn Ave Name(Print) Cupenl Mailing Addmss'. See attached sinned contract Telephone Signature 2.2 Authorized Adept: Keifer Builders, Inc. 35 Main Street Florence, MA 01062 Nam rmq�/ Current Mailing Address. 413.586-8600 S' lure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by Permit applicant 1. Building (a)Building Permit Fee 163.672 2. Electrical (b)Estimated Total Cost of 7.180 Construction from 6 - 3 Plumbing BDIldInR Permit Fee 9 I j Da 4. Mechanical(HVAC) 19,2.29 99 ��(J 5. Fire Protection 0 6. Total=(1 +2 +3+4+5) 200,000 Check Number This Section For Official Use Only Building Permit Number: Date Issued Signature- Building Commissioner/Inspector of Buildings Date BGrant @ KeiterBuilders.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) i Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information f5xisling Propnscd Required by Zoning lTr calwnn m be fille4 In by linildmg bePanment Int Size Fronto e Schicks From Side 1, R: I.: R: Rev Building Height Bldg.Square Footage k: Open Space Footage T Q.area mini,,bldg&pm of rkln ) Hof Parkin Spaces Fill: n0bune&Iax1flonl A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T 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 (2) 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 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 0 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 f acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. it I SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(.) � Roofing Q Or Doors ED Accessory Bldg. ❑ Demolition ❑ New Signs iol Decks [q SI01ng[Oj Other[0] Brief DesFFn�ptiyn of Praposetl � '" Work: Y r t C�I.IM fQ,Ll.f I K-Q.(,l) oCpvi .L//, Alteration of existing bedroom----Yes S—No Adding new bedroom_Yes X—No Attached Narrative Renovating unfinished basement _Yes x _No Plans Attached Roll .Sheet ea. 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 attai of 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 attache0 h. Type of construction I. Is construction within 100 0of 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? y Yes No 1. Septic Tank City Sewer\ Private well City water Supply)_ SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Esther It Matthew Roth-Katz .as Owner of the subject property hereby authorize KP ter Rij'lrlpm Inc to act on my behalf,in all matters relative to work authorized by this building permit application. See attached signed contract 5.1_3.19 Snature of Owner Dale I. Ke ter But Iders. 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. Rrnp Ke tar Print NrL & 5.1319 Sin ria�l a o r) ent Dale SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Scott Keifer CS-102457 License Number 51 A Hatfield St Northampton. MA 01062 6.20.20 Aaar{/e/$/{� Expiration Date GoC- Q..Lt tr 413-586-8600 Sig ature Ielephpne 9.Realstered Nome Improvement Contractor: Not Applicable ❑ Keiter Builders, Inc. 175168 Company Name Registration Number 35 Main St Florence MA 01062 4.28.21 Address Expiralion Dale Skeiter@KelterSuilders.Com Telephone413.586.8600 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Womers 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—_. ❑ City of Northampton Massachusetts (�..� __NT OF BUILDING INSPECTIONS 212 Mein Street •Munlcipel Boild.' '—u,am ton, M 01060 Debris 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. The debris from construction work being performed at: 21 Woodlawn Ave (Please print house number and street name) Is to be disposed of at: Valley Recycling (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Duseau Trucking (Company Name and Address) /-/�.P.rmit ts; 5.13.19 ate gnature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ulf; I Congress Street,Suite 100 Boston,MA 02114-2017 www,inass.govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Nosiness/Organization/IndividuapKeiler Builders, Inc: Address:35 Main Street City/stale/Zip: Florence, MA 01062 Phone fl;413.586.8600 Are you an employer? Check the appropriate box: Type of project(required): 1.2 1 am a employer with 20 4. 0 1 am a general contractor and I employees(full and/or l-time).< have hired the sub-contractors 6. .® New construction par 2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-con(racum have g, ® Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp, insurances required,] 5. ® We are a corporation and its 10.0 Electrical repairs or additions 3.® 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.® Rcof repairs insurance required.] ` c. 152. ¢1(4).and we have no employees. [No workers' 1311 Other comp. insurance required./ Any upploani thel Ocek5 hoc sl nrust,ilsn till out the,cellon bclmv showing their workers.'compensmion policy hil'nnnntinn. ` 11 onsnwners ctho soon.it this u0idacll Inrlkwinp Ihey are doing all walk and then hire ouside enutmetors must subntil a new o I'lidavit indiculingsuch. k'ootructors that check this bn.e must wniched on uddilinnul sheet sharing the mew of the sub-connnetors and state whether or not IhoK eninlics hate curl If the suh-umtractors hm c cniploytts.they must provide their to rkcri enmp.Iwlip number. I am nn employer that is providing Iwirkers'conrpensntian intarrance for itty emphirees. Relory is the ptdicv and job site information. AIM Mutual Insurance Company Name: Policy d or Self-ins. Lic. d;MCC20020005382018A I'ytiration Dale:6.11 .2019 21 Woodlawn Ave Northampton Job Site Address: __. . __.. . Gilt.sl:nc/Zip:_ Attach a copy orthe workers' compensation policy declaration page(shoring 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 tine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a S'T'OP WORK ORDER and a line of up to$250.00 a day against the violator. Be advised that a copy of(his statement may he forwarded to the Office of Investigations of the DIA for insurance coverage verification. l dohereby reify order the pains'and penalties of perjun'that the infonnalion provided above is tree and correct. "rI'rcsidrnt. Keifer Ituildrr.. Ino. 5.13.19 ature ""�`-' S'un , Date Phone d: 411586 8600 Official use only. Do nol write in this area,to be cont plater/by tip or tam,n official. City or Town: Permit/License A Issuing Authority (circle one): 1.Boatel orllcalth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone k: III�� AC RO be CERTIFICATE OF LIABILITY INSURANCE 0511]12018 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cacti icato holder is an ADDITIONAL INSURED,the policylles)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject Be the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate dopa not confer right.to the certificate holder in lieu of such endorsement(s). PXOOUCEN CONTACT Cynthia HendowNCISR Elite RARE Warier B Grinnell 'A'�%rfsg (4131586-0111FAK (413)58&6481 cn No B NOnn King$Neel nMnnlL 5_ cheridersonowelcoracignonell COM MSUHEHISINfORDINGCOALUAGE NAICM Northampton MA 01080 IxsuRERn. Selective Ins Cool S Carolina INSURE. INSURER 6, AI M.MWXa"A.IM Keifer Builders,Inc. AU'L RC. _ Am SOON Kne, INSUHLRO 35 Main Street NsuRBRF Florence MA 01062 INSURER COVERAGES CERTIFICATE NUMBER: Master Exp 2019 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 CONTRACTOR OTHER DOCUMENT VITH RESPECT TO MICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED 13Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS BROWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN.,a TYFEOFINSURANCE NOUCYNUMBER MMIDIYL OMID YYV MMCY EFF IO � LIMITS T�MERCIALG��LWBIUTY EACH OCCURRENCE E 1'000'000 LUIM5.MP0E DOLOUR PROMISESTIECATEAMX E 500.000 MEOBWURT—AMORT 516'000 A $22135557 0610112018 0610"ROt9 PBRSONALIFDvilill a 7000000 GEN L.IGGREGATE LIMIT APPLIES PER GENERALAGGREWTE E 2'000000 ALL ICV❑,E?T ❑LOC PRODUCTS GGMPNPAGG 5 2000000 OTHER AUTOMOBILE LIABILITY CpABINE051NGLE lIMIT 5 11000.000 NY WTO BOGILY INJURY Pc wnonl s A TCA*NEOxly SuiOSULED A9105217 0510112018 '0510112019 Boor INJURY IP,,—der, s xHIRED XONOANEp nROPEN� MnGb. s AJIO50NLY AUTOSONLV Medical Payments s 5,000 X UM BRELLALIAS —UP EACNOCCUNRPNCE s 5000000 A Excess LAB OICIMS-Al 5226556] 05101120"6 08/0112019 AGGaBG, s 5,000,000 DeO X aETErvilon E "0,000 E WORHERSCOMPENSARO" x PiAR T OTH- ANOEMPLOYERS'LIABIOTY YIN R ANY PROPRIETORPARTNEWEXECOTIVE EL EACHACCIDEM 51000,000 B ffFlCERMEMaeR ExcwoeGP MNIAMCC2002000538201M 06111F2018011112019 — IMRoalarVlnNm EL B156AAF-EAEMPIOYEE s IGIMBEL OESCULATIONGFOPERATICARTANr EL OISEARI-POL,CVLIEN 51000000 DESCRIPTION OF WERAl10H61LOCATONSI VEHICLES IACORO 101,AWnlonal RemaNS YNWUIe,maV N aNCMd it mart caeca is na,,m l 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 1 ©191 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD Vreeland Design Associates Sht. 1 of_I An integrative approach to design, engineering and site planning Re: 21 Woodlawn Ave, Northampton, MA: Roof framing details for 10' shed dormer. Note: The proposed shed dormer, the width of the existing ridge line of the hip roof, is supported on pairs of built-up girder rafters that are secured to the existing floor assembly with welded steel brackets and prevent the girder rafters from spreading apart. The rafters, parallel with the ridge are a minimum of 2x6 @ 16" o.c. or 2x8 @ 24"o.c. supported on 2x6 stud walls framed on lop of the girder rafters. fdL Girder Rafter roof&suppoding ge beam with HUS48 Hangers \ 1\y l� E 8"z3-112"z 3/6"z 3'Long Angle screwed totopwall/floor V 3"x 3/16"side otates welded to angle&strap plate I 8'x 3116'strap plate welded to angle J 3-Ledg&Loks wto each jrnst 3H� O DAVID A. 6G VRE"ND ' o CIVIL y No.46317 4 S AL 5/19/19 116 River Road, Leyden, MA 01337 Phone: (413) 624-0126 Email: dvreeland@verizon.net Fax: (413) 624-3282 CHILD'S PARK 35 Wo mn Ave. 38 WoodWon Ave. WOODLAWN AVE. 25 Woodlawn Ave. 2644 Massasan Street 9�iat ingg Setbacks a 46' 242 Dormer to Rear Llne 36 Massaso6 Street 21 Woodlawn Avenue 17 WoadM Ava. 24 Massasoit Street 16 Massasoit Street 12 Massasod Street 333 Elm Street t / 16 MaseasoR Street KEITER BUILDERS r� BLOCK PLAN MASSASOIT STREET Roth Katz Remodel 5/20/19 No change to existing setbacks